Analysis of 516 cases of revision total elbow arthroplasty from the Dutch Arthroplasty Registry:centralization of care is the future

Background: The number of revision total elbow arthroplasty (TEA) remains relatively low. As a result, there are relatively few orthopedic surgeons and a limited number of centers with substantial expertise in revising TEA. This study provides a comprehensive description of the current practice concerning revision TEA in a northern European Country based on the data of the Dutch National Implant Registry. Methods: Data of all revision TEA procedures performed between 2014 and 2022 were extracted from the national registry, including cases where the primary procedure was either not recorded in the registry or was not a TEA. Descriptive statistics were used to report the current practice of revision TEA in the Netherlands. Results: Five hundred sixteen revision TEAs were performed in the Netherlands between 2014 and 2022. Eighty-four elbows required more than one revision during that period. The primary cause for revision was aseptic loosening 51%. The procedures were performed in 35 centers, and 21/35 centers performed 5 or less revision procedures per year. No center performed 20 or more revision procedures per year. Discussion: All types of elbow arthroplasty are associated with a considerable rate of complications, and a direct volume-outcome relationship exists in these surgical procedures. Despite the considerable complication rate, the volume of revision TEA remains low, primarily due to the infrequent occurrence of primary procedures. Conclusion: The study reported that aseptic loosening was the primary reason for revision TEA. We recommend centralizing infrequent surgical procedures such as revision TEA in selected highly specialized centers to increase surgeon and center volumes, aiming to yield more favorable outcomes.</p

Analysis of 516 cases of revision total elbow arthroplasty from the Dutch Arthroplasty Registry:centralization of care is the future

Background: The number of revision total elbow arthroplasty (TEA) remains relatively low. As a result, there are relatively few orthopedic surgeons and a limited number of centers with substantial expertise in revising TEA. This study provides a comprehensive description of the current practice concerning revision TEA in a northern European Country based on the data of the Dutch National Implant Registry. Methods: Data of all revision TEA procedures performed between 2014 and 2022 were extracted from the national registry, including cases where the primary procedure was either not recorded in the registry or was not a TEA. Descriptive statistics were used to report the current practice of revision TEA in the Netherlands. Results: Five hundred sixteen revision TEAs were performed in the Netherlands between 2014 and 2022. Eighty-four elbows required more than one revision during that period. The primary cause for revision was aseptic loosening 51%. The procedures were performed in 35 centers, and 21/35 centers performed 5 or less revision procedures per year. No center performed 20 or more revision procedures per year. Discussion: All types of elbow arthroplasty are associated with a considerable rate of complications, and a direct volume-outcome relationship exists in these surgical procedures. Despite the considerable complication rate, the volume of revision TEA remains low, primarily due to the infrequent occurrence of primary procedures. Conclusion: The study reported that aseptic loosening was the primary reason for revision TEA. We recommend centralizing infrequent surgical procedures such as revision TEA in selected highly specialized centers to increase surgeon and center volumes, aiming to yield more favorable outcomes.</p

Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results

Aim: Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone. Materials and methods: A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18–84 years) and mean total follow-up was 43 months (range, 24–62 months). Results: All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated. Conclusion: The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations. Clinical significance: The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications

Clinical and radiographic outcome of revision surgery of total elbow prosthesis: midterm results in 19 cases

The aim of this study is to report on the midterm outcomes and complications of revision surgery of total elbow arthroplasty. All patients who had undergone total elbow arthroplasty revision surgery between 2009 and 2014 with semiconstrained total elbow prostheses were prospectively enrolled in the study. Records were reviewed for demographic data; baseline measurements; and several follow-up assessments including the Mayo Elbow Performance Score (MEPS), visual analog scale (VAS) score for pain, Oxford Elbow Score, range of motion, satisfaction, and radiographs. A total of 19 revision arthroplasties were included. At a mean follow-up of 57 months, there had been 1 rerevision and 2 removals. One patient was excluded from follow-up because of confounding comorbidity. At last follow-up, MEPS values and VAS pain scores both improved (P  < .01). The rate of combined good and excellent results on the MEPS was 53%. The mean VAS scores for pain at rest and with activity were 2 and 4, respectively. Fair results for the Oxford Elbow Score were reported, with a mean score of 28 points. Range of motion improved to an average flexion-extension arc of 108° (P  < .01), and the pronation-supination arc improved to an average of 123° (P  < .01). All elbows were stable at last follow-up (P  < .01). Radiographs showed nonprogressive osteolysis around the prosthesis in 3 cases (19%) and suspicion of loosening in 1 (6%). In 11 patients postoperative complications occurred. Of 15 patients, 13 (87%) were satisfied with the result of the revision procedure. Revision of total elbow prostheses leads to satisfactory results, less pain, and better elbow function. This procedure is related to a relatively high complication rat

Grafting and fixation after aseptic non-union of the humeral shaft: A case series

Purpose: Non-unions after humeral shaft fractures are seen frequently in clinical practice at about 2–10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. Methods: From 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. Results: In all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. Conclusion: Given the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft

Global trends in indications for total elbow arthroplasty: A systematic review of national registries

National registries provide useful information in understanding outcomes of surgeries that have late sequelae, especially for rare operations such as total elbow arthroplasty (TEA). A systematic search was performed and data were compiled from the registries to compare total elbow arthroplasty outcomes and evaluate trends. We included six registries from Australia, the Netherlands, New Zealand, Norway, the United Kingdom and Sweden. Inflammatory arthritis was the most common indication for total elbow arthroplasty, followed by acute fracture and osteoarthritis. When comparing 2000-2009 to 2010-2017 data, total elbow arthroplasty for inflammatory arthritis decreased and total elbow arthroplasty for fracture and osteoarthritis increased. There was an increase in the number of revision TEAs over this time period. The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. However, inflammatory arthritis remains the most common indication in recent years. This change is accompanied by an increase in the incidence of revision surgery

Effect of trochleocapitellar index on adult patient-reported outcomes after noncomminuted intra-articular distal humeral fractures

Background: Anatomic surgical reduction of intra-articular fractures of the distal humerus is important to achieve the best long-term outcomes and prevent post-traumatic arthritis. In this study we compared the radiographic reduction using the trochleocapitellar index. We also correlated the trochleocapitellar index to the functional outcomes next to the comparison of the triceps brachii lifting approach and olecranon osteotomy approach, 2 common approaches for distal humeral fractures. Methods: From January 2006 to June 2016, patients with elbow fractures were registered in 4 centers. The trochleocapitellar index, a ratio between the angle of the capitellum and the trochlea to the midline of the distal humerus on anterior-posterior radiographs, was calculated for included patients. Functional outcomes were measured using the Oxford Elbow Score and the Mayo Elbow Performance Score. Bone healing was measured using radiographic union scoring. Results: There were 86 patients enrolled: 46 in the olecranon osteotomy group and 40 in the triceps lifting group. Functional outcomes and bone healing did not differ between the approaches. Functional results had a medium correlation with the trochleocapitellar index, which did not differ between the 2 approaches (olecranon osteotomy group, κ = 0.56; triceps lifting group, κ = 0.57; P =.7932). Conclusions: The trochleocapitellar index has a moderate predictive value on the functional results after 12 months after open reduction and internal fixation of intra-articular distal humeral factures. There is no difference in reduction, as measured by trochlear index and functional outcome scores, between the olecranon osteotomy approach and the triceps brachii lifting approach groups

The Waterfall Fascia Lata Interposition Arthroplasty “Grika Technique” as Treatment of Posttraumatic Osteoarthritis of the Elbow in a High-Demand Adult Patient: Validity and Reliability

Introduction. The elbow interposition arthroplasty is a very common procedure performed mainly on active young patients who need great functionality and for whom total joint replacement is contraindicated and arthrodesis is noncompliant. We are going to demonstrate a case of a 34-year-old male suffering from malunion of the distal humerus, elbow stiffness, and manifest signs of arthrosis of the dominant limb, treated with the IA Grika technique at a 5-year follow-up. Patients and Methods. The chosen criteria to evaluate the injured side and the uninjured side during the clinical and radiological follow-up were the objective function and related quality of life, measured by the Mayo Elbow Performance Score (MEPS), and postoperative complications. To assess flexion and supination forces and elbow muscular strength, a hydraulic dynamometer was used. Results. At a 5-year follow-up, the results were excellent as during the first year. Conclusions. The Grika technique is a valid and feasible option in the treatment of elbow injuries