Mid- and Long-Term Results of Total Elbow Arthroplasty: Post-Traumatic Consequences and Rheumatoid Arthritis

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Abstract

Objective of the study: to identify differences in the functional outcomes of total elbow arthroplasty in posttraumatic and rheumatoid cases, to determine the factors affecting the outcomes and rate of the complication.

Materials and methods. A retrospective study included 269 patients (272 elbows), who underwent primary total elbow arthroplasty (TEA), 100 men (37.2%), and 169 women (62.8%). The first group included 191 patients (191 elbows) who had elbow trauma. The average follow-up after the operation was 6.9 years (from 0.5 up to 21 years). The compared group included 78 patients (81 elbows) operated on for rheumatoid arthritis (RA). The average follow-up time after total elbow arthroplasty was 3.8 years (0.4 to 16.5 years).

Results. Tea significantly improved joint function (mean values in post-trauma patients on the Mayo score were 73.8±14.1 points, on the oxford questionnaire — 30.5±8.9, DASH — 40.3±18.4, EQ-5D — 0.536±0.234; in patients with rheumatoid arthritis, on the Mayo score — 75.4±15.5 points, DASH — 38.6±15.8, OES — 35.5±7.9, EQ-5D — 0.580±0.2). In the first group, the frequency of postoperative complications requiring a revision was significantly higher than in the compared group (23.8% and 13.6%, respectively, OR 3.2; 95% CI 0.7-3.0). In the first group, a statistically significant risk of aseptic loosening of the implants was observed in patients operated on for pseudarthrosis of the distal humerus (OR 8.5; 95% CI 1.7-43.6) and post-traumatic deformity (OR 10.5; 95% CI 1.3-88.5). The use of some endoprostheses is also associated with a high risk of aseptic instability (OR 3.5; 95% CI 0.9-13.3). A significant risk of a deep periprosthetic infection was observed in patients with post-traumatic bone defect (OR 7.0; 95% CI 1.2-40.1) and post-traumatic deformity of the elbow joint (OR 14.0; 95% CI 2.5-77.8). Risk factors for loosening endoprostheses in patients with RA were: defective cementation of humeral component (OR 35.0; 95% CI 3.8325.0), valgus deviation of the humeral component >9° (OR 9.2; 95% CI 1.0-82.2), low constructive reliability of the endoprosthesis (OR 13.6; 95% CI 2.3-79.4), patient age >59 years (OR 12.8; 95% CI 1.5-113.0 ), BMI >32 kg/m2 (OR 8.4; 95% CI 1.5-47.5), and CRP level >36.1 mg/l (OR 4.8; 95% CI 0.4-65.8).

Conclusion. Mid-term and longterm results showed that TEA helps restore the amplitudes of elbow movement and the function of the limb, both in elbows with post-traumatic consequences and with RA. However, the frequency of postoperative complications requiring a revision is significantly higher in the group of patients with consequences of the fractures than in the group of patients with RA.

About the authors

A. G. Aliev

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: mur23mur@yandex.ru

Alimumd G. Aliev — PhD student.

St. Petersburg

Russian Federation

A. V. Ambrosenkov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Andrei V. Ambrosenkov — cand. Sci. (Med.), the head of Hip, Knee and Elbow Pathology Department.

St. Petersburg Russian Federation

A. A. Boyarov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Andrei A. Boyarov — cand. Sci. (Med.), orthopedic surgeon, Hip, Knee and Elbow Pathology Department.

St. Petersburg Russian Federation

G. I. Zhabin

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Georgii I. Zhabin — Dr. Sci. (Med.), professor, orthopedic surgeon, Hip, Knee and Elbow Pathology Department.

St. Petersburg

Russian Federation

A. A. Dzhavadov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Alisagib A. Dzhavadov — clinical resident.

St. Petersburg

Russian Federation

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