Use and outcome of 1,220 primary total elbow arthroplasties from the Australian Orthopaedic Association National Joint Arthroplasty Replacement Registry 2008–2018

Abstract

Background and purpose — The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) was analyzed to determine trends in use of primary total elbow arthroplasty (TEA), the types of prostheses used, primary diagnoses, reasons for and types of revision, and whether the primary diagnosis or prosthesis design influenced the revision rate.Patients and methods — During 2008–2018, 1,220 primary TEA procedures were reported of which 140 TEAs were revised. Kaplan–Meier estimates of survivorship were used to describe the time to first revision and hazard ratios (HR) from Cox proportional hazard models, adjusted for age and sex, were used to compare revision rates.Results — The annual number of TEAs performed remained constant. The 3 most common diagnoses for primary TEA were fracture/dislocation (trauma) (36%), osteoarthritis (OA) (34%), and rheumatoid arthritis (RA) (26%). The cumulative percentage revision for all TEAs undertaken for any reason was 10%, 15%, and 19% at 3, 6, and 9 years. TEAs undertaken for OA had a higher revision rate compared with TEAs for trauma (HR = 1.8, 95% CI 1.1–3.0) and RA (HR = 2.0, CI 1.3–3.1). The Coonrad-Morrey (50%), Latitude (30%), Nexel (10%), and Discovery (9%) were the most used prosthesis designs. There was no difference in revision rates when these 4 designs were compared. The most common reasons for revision were infection (35%) and aseptic loosening (34%).Interpretation — The indications for primary and revision TEA in Australia are similar to those reported for other registries. Revision for trauma is lower than previously reported.

Osteomyelitis variolosa, an issue inherited from the past: case report and systematic review

“…Total elbow arthroplasty (TEA) is an effective treatment choice for patients with severe pain or instability of the elbow or for patients requiring high-quality motion [ 48 ]. However, there is a risk of long-term complications after TEA, such as aseptic loosening, infection, and polyethylene or bushing wear [ 49 ]. Elbow deformity in patients with osteomyelitis variolosa is often combined with distal humeral dysplasia, lengthening of the condyles of the humerus, and distortion of the long bones [ 13 , 25 ], which further increases the operating difficulty of TEA.…”

A review of registry research

“…In their article published in Acta Orthopaedica in August 2019, Viveen et al reported on 1200 primary total elbow replacements from the Australian Orthopaedic Association National Arthroplasty Replacement Registry (AOANARR) implanted between 2008 and 2018. 13 They observed an almost equal three way split for indication of TEA between trauma, osteoarthritis (OA) and rheumatoid arthritis (RA) overall, but in more recent times (since 2016) trauma and OA are becoming more common whilst RA is decreasing in frequency, likely due to the improved medical management of RA. TEA performed for OA appeared to show a higher revision rate compared to trauma (HR 1.8 95% CI 1.1, 3.0) and RA (HR 2.0 95% CI 1.3, 3.1).…”

Arthroscopic Transhumeral Ulnohumeral Arthroplasty

“…Although an arthroscopic arthroplasty is the preferred choice in terms of surgical possibilities, the symptoms and grade of the OA should be considered. Other surgical options include a debridement only with loose body removal, or total elbow replacement or in severe cases an elbow arthrodesis may be applicable, depending on the patient presentation and activity demands [15]. The patient should be informed about the progression of the OA in general and that the surgery cannot prevent further progression of osteoarthritic changes with time.…”