Midterm results of radiocapitellar arthroplasty of the elbow: a multicentre prospective study on two different implants.

AIMS: The aim of this study was to analyze the results of two radiocapitellar prostheses in a large case series followed prospectively, with medium-term follow-up. PATIENTS AND METHODS: A total of 31 patients with a mean age of 54 years (27 to 73) were analyzed; nine had primary osteoarthritis (OA) and 17 had post-traumatic OA, three had capitellar osteonecrosis, and two had a fracture. Overall, 17 Lateral Resurfacing Elbow (LRE) and 14 Uni-Elbow Radio-Capitellum Implant (UNI-E) arthroplasties were performed. Pre- and postoperative assessment involved the Mayo Elbow Performance Score (MEPS), the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and the modified American Shoulder Elbow Surgeons (m-ASES) score. RESULTS: The mean follow-up was 6.8 years (3.8 to 11.5). The mean MEPS, m-ASES, and Q-DASH scores improved significantly by 50 (p < 0.001), 55 (p < 0.001), and 54 points (p < 0.001), respectively, with no differences being detected between the implants. Preoperative pronation and supination were worse in patients in whom the UNI-E was used. Two patients with the UNI-E implant had asymptomatic evidence of gross loosening. CONCLUSION: Radiocapitellar arthroplasty yielded a significant improvement in elbow function at a mean follow-up of 6.8 years, with a high implant survival rate when the LRE was used in patients with primary or post-traumatic OA, without radial head deformity, and when the UNI-E was used in patients in whom radial head excision was indicated. Cite this article: Bone Joint J 2019;101-B:1362-1369.

Artroplastia total de codo para el tratamiento de fracturas del húmero distal / Total elbow arthroplasty for the treatment of distal humeral fractures

Objetivo. Reportar los resultados clínico-radiológicos del tratamiento de las fracturas del húmero distal (FHD) con prótesis total de codo. Material y métodos. Este trabajo retrospectivo fue realizado en 2 centros quirúrgicos. Se incluyeron: pacientes con FHD, operados con prótesis total de Coonrad-Morrey y con seguimiento > 1 año. Se incluyeron 23 pacientes. Veintiuno de los pacientes eran mujeres con una edad promedio de 79 años. Según la clasificación AO, las fracturas eran: 15 del tipo C3, 7 del tipo C2 y una A2. Todos los pacientes fueron operados sin desinserción del aparato extensor. El seguimiento promedio fue de 40 meses. Resultados. La flexoextensión fue de 123-17°, con un arco de movilidad de 106° (un 80% con respecto al lado sano). El dolor según EVA fue de un punto. El SCM promedio fue de 83 puntos: 8 pacientes tuvieron resultados excelentes, 13 buenos, uno regular y otro malo. El DASH promedio fue de 24 puntos. No se evidenciaron aflojamientos en 15 pacientes. Se observaron 10 complicaciones: 2 desgastes del polietileno, un desensamble protésico, 3 parestesias postoperatorias del nervio cubital, una necrosis de piel que necesitó un colgajo braquial, 2 aflojamientos protésicos, y una falsa vía intraoperatoria. Conclusiones. El tratamiento de FHD con prótesis total de codo puede ofrecer una opción razonable de tratamiento, pero las indicaciones deben estar limitadas a fracturas complejas donde la fijación interna puede ser precaria, en pacientes con osteoporosis y con baja demanda funcional. En pacientes jóvenes la utilización está limitada a casos graves donde no exista otra opción de tratamiento. Nivel de evidencia. Nivel de evidencia IV (AU)

Objective. To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. Material and methods. This retrospective study was performed in two surgical centres. A total of 23 patients were included, with a mean age of 79 years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15 fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. Results. Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. Conclusion. Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. Level of Evidence. Level of Evidence IV (AU)

Total elbow arthroplasty: a radiographic outcome study.

OBJECTIVES: Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. MATERIALS AND METHODS: This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. RESULTS: A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). CONCLUSIONS: Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist.

Tratamiento de la Triada Terrible de codo con prótesis de cúpula radial / Treatment of terrible triad of the elbow with radial head prosthesis

Introducción: Las fracturas de cabeza radial representan 30 casos/100000 habitantes/año. Constituyen el 33-75% de las fracturas del codo. La "Triada terrible de Hotchkiss" se caracteriza por fractura de cúpula radial, coronoides y luxación del codo. Nuestro objetivo es valorar los resultados del tratamiento con artroplastia de cabeza radial. Material y métodos: Estudio observacional, descriptivo y retrospectivo. Tamaño muestral de 22 pacientes. Variables analizadas: filiación, clasificación de Mason, aspectos quirúrgicos (demora, tiempo quirúrgico, tipo de prótesis, reintervenciones), tiempo rehabilitador, causas de fracaso protésico, complicaciones, hallazgos radiológicos (según Van-Riet), zonas de aflojamiento (Popovic), escalas M.E.P.S. y Cassebaum. Resultados: Edad media: 42,2 ± 9,9 años. 72.7% profesionales de grandes esfuerzos. La fractura Mason IV fue la más frecuente (72.7%) y la tipo I de Regan Morrey para coronoides (50%). Tiempo de intervención: 130,4 ± 79,8 minutos. Fijación externa en el 13.6%. M.E.P.S. final: 84,1 ± 15,7 puntos. Tiempo rehabilitador: 4,2 ± 1,4 meses. Alta por mejoría: 72.7%. Cassebaum bueno-excelente en el 85.7%. Hubo 13.6% de movilización protésica, 45.5% de osificaciones heterotópicas y sobredimensionado en el 22.7%. Conclusiones:: No hubo diferencias estadísticamente significativas en cuanto al momento quirúrgico, tipo protésico o tipo de fractura de coronoides. Tan sólo en este último punto hubo más riesgo de infección a mayor tipo de Regan, asociado a una mayor manipulación quirúrgica. El tratamiento de la triada terrible con prótesis de cúpula radial, en nuestra experiencia arrojó buenos resultados, aunque no está exento de complicaciones

Introduction: Radial head fractures represent 30 cases/100,000 population/year. They constitute 33- 75% of elbow fractures. 'Terrible Triad’s Hotchkiss' is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our goal is to review results of treatment with radial head arthroplasty. Material and methods: Observational, descriptive and retrospective study. Sample size of 22 patients. Variables analyzed were affiliation, Mason’s classification, surgical aspects (moment of surgery, surgical time, type of prosthesis, reoperation), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to Van Riet), Popovic’s loosening areas, MEPS and Cassebaum’s scales. Results: Average age: 42.2 ± 9.9 years. 72.7% realized high demanding jobs. Mason’s fracture type IV was the most frequent (72.7%) and the Regan-Morrey’s type I was the most frequent of coronoid fracture (50%). Surgery time: 130.4 ± 79.8 minutes. External fixation was used in 13.6%. M.E.P.S. final: 84.1 ± 15.7 points. Rehabilitation time: 4.2 ± 1.4 months. 72.7% of patients came back to work. Cassebaum’s results were good-excellent in 85.7% of patients. There were 13.6% of prostheses mobilization. heterotopic ossification appeared in 45.5% of cases and 22.7% presented overstuffing. Conclusions: There was no statistically significative difference about moment of surgery, prosthetic type, or coronoid fracture. Just about this last point there was more risk of infection when there was a worse Regan-Morrey’s type, probably due to greater surgical manipulation. Treatment of the terrible triad with radial head prosthesis, in our experience, yielded good results, although it is not without complications

Artroplastia de codo / Elbow replacement

La artroplastia de codo representa una buena alternativa terapéutica para un gran porcentaje de pacientes con importante destrucción articular. Sin embargo, muchos cirujanos ortopédicos no están familiarizados con los abordajes o técnicas quirúrgicas relacionados con la sustitución protésica del codo. Además, la incidencia de complicaciones es superior a la de la artroplastia de otras articulaciones, siendo las más importantes, la infección, el fracaso mecánico, la neuropatía cubital y las alteraciones del tríceps. Por estos motivos, la utilización de artroplastia de codo en el medio español puede que sea inferior a la ideal. Aunque las artropatías inflamatorias, como la artritis reumatoide, constituyen la indicación más frecuente para este tipo de intervención, las fracturas de húmero distal y la afección postraumática representan una indicación creciente. Este trabajo intenta resumir los conceptos actuales más importantes relacionados con la artroplastia de codo (AU)

Elbow replacement or arthroplasty is a good therapeutic option for a large percentage of patients with significant joint destruction. However, many orthopaedic surgeons are no familiar with the surgical approaches or techniques associated with elbow replacement implants. Furthermore, the incidence of complications is higher than in other joint replacements, the most important being infections, mechanical failure, cubital neuropathy, and problems with the triceps. For these reasons, the use of bone arthroplasty in Spain may be less than ideal. Although, inflammatory arthritic diseases, such as rheumatoid arthritis, are the most frequent indication for this operation, distal humerus fractures and post-traumatic disease are a growing indication. This work attempts to summarise the most important current concepts associated with elbow replacement (AU)