Early Mobilization and Functional Discharge Criteria Affecting Length of Stay after Total Elbow Arthroplasty

PURPOSE OF THE STUDY Decline in length of stay is of growing interest for patients, doctors and health insurances. The aim of our study was to assess the safety and length of stay after omission of casting, start of early mobilization and implementation of functional discharge criteria after total elbow arthroplasty (TEA). MATERIAL AND METHODS We retrospectively reviewed all patients' records who received a Coonrad-Morrey TEA in the period from January 1st, 2011 to December 31st, 2018. From these records, indications, demographic information and complications were derived. Length of stay was calculated from the hospital administration. Patients were divided in three groups to evaluate the two changes in post-operative care. RESULTS In total 125 patients receiving 126 Coonrad-Morrey TEAs were included with a mean length of stay of 5.5 days (range 2- 23) for the entire group. Omitting a post-operative cast led to decline in length of stay from 6.2 to 5.4 days (p < 0.001). Introduction of functional discharge criteria in August 2017 declined mean length of stay to 3.8 days (p < 0.001). The surgical technique (triceps-on versus triceps-off) was not a confounder (p = 0.20). Range of motion after one year was not significantly different between groups. DISCUSSION The length of stay declined after omission of a cast, and declined further after introducing functional discharge criteria. Since no higher complication rates were observed, the shortening of length of stay appears to be safe. This is in line with other fast-track programs, i.e. for hip and knee arthroplasty. The surgical technique used were not a confounder for the shortened length of stay, which further adds to the safety of the functional discharge criteria. CONCLUSIONS Omitting a cast and splint as regular post-operative treatment reduced the length of stay significantly without leading to more complications. Introduction of functional discharge criteria lowered the length of stay further without more complications. Key words: fast track rehabilitation, cast, total elbow arthroplasty, length of stay, discharge, complications

Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry

Aims The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. Methods All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. Results A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statisti-cally significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. Conclusion This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions

Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry

Aims: The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. Methods: All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. Results: A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statistically significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. Conclusion: This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions. Cite this article: Bone Jt Open 2023;4(2):110–119

Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry

Aims The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. Methods All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. Results A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statisti-cally significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. Conclusion This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions

Comparison of isometric triceps brachii force measurement in different elbow positions

Purpose: Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach–based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm. Methods: Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test–retest reliability using intraclass correlation. Results: We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2–6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted. Conclusion: The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed

Comparison of isometric triceps brachii force measurement in different elbow positions

Purpose: Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach–based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm. Methods: Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test–retest reliability using intraclass correlation. Results: We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2–6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted. Conclusion: The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review

• Purpose: Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called ‘high-volume’ hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA. • Methods: A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale. • Results: Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found. • Conclusions: Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged

Multilevel fine-scale diversity challenges the ‘cryptic species’ concept.

‘Cryptic’ species are an emerging biological problem that is broadly discussed in the present study. Recently, a cryptic species definition was suggested for those species which manifest low morphological, but considerable genetic, disparity. As a case study we present unique material from a charismatic group of nudibranch molluscs of the genus Trinchesia from European waters to reveal three new species and demonstrate that they show a dual nature: on one hand, they can be considered a ‘cryptic’ species complex due to their overall similarity, but on the other hand, stable morphological differences as well as molecular differences are demonstrated for every species in that complex. Thus, this species complex can equally be named ‘cryptic’, ‘pseudocryptic’ or ‘non-cryptic’. We also present evidence for an extremely rapid speciation rate in this species complex and link the species problem with epigenetics. Available metazoan-wide data, which are broadly discussed in the present study, show the unsuitability of a ‘cryptic’ species concept because the degree of crypticity represents a continuum when a finer multilevel morphological and molecular scale is applied to uncover more narrowly defined species making the ‘cryptic’ addition to ‘species’ redundant. Morphological and molecular methods should be applied in concordance to form a fine-scale multilevel taxonomic framework, and not necessarily implying only an a posteriori transformation of exclusively molecularbased ‘cryptic’ species into morphologically-defined ‘pseudocryptic’ ones. Implications of the present study have importance for many fields, including conservation biology and fine-scale biodiversity assessments