Niloofar Dehghan1, Matthew Furey2, Laura Schemitsch3, Bill Ristevski4, Thomas Goetz5, Emil H Schemitsch6, Michael McKee7. 1. Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA; The CORE Institute, Phoenix, AZ, USA. 2. Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. 3. Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada. 4. Department of Surgery, McMaster University, Hamilton, ON, Canada. 5. Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada. 6. Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada. 7. Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA. Electronic address: michael.mckee@bannerhealth.com.
Abstract
BACKGROUND:Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture. METHODS: Patients from a previously published randomized controlled trial of 42 patients in whichTEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival. RESULTS: Data were obtained for 40 patients, 15 treated with ORIF and 25 treated withTEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up. CONCLUSIONS:TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.
RCT Entities:
BACKGROUND:Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture. METHODS:Patients from a previously published randomized controlled trial of 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival. RESULTS: Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up. CONCLUSIONS: TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.
Authors: Paolo Schiavi; Francesco Pogliacomi; Alice Garzia; Piergiulio Valenti; Francesco Ceccarelii; Filippo Calderazzi Journal: Acta Biomed Date: 2020-12-30
Authors: Eliana B Saltzman; Daniel R Evans; Albert Anastasio; Ndeye Guisse; Elshaday S Belay; Oke A Anakwenze; Mark J Gage; Tyler S Pidgeon; Marc J Richard; David S Ruch; Christopher S Klifto Journal: JSES Int Date: 2021-09-17