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

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.