Indications and outcome in total elbow arthroplasty: A systematic review

Background Total elbow arthroplasty (TEA) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications. The aim of this study is to review the literature to evaluate the evolution of surgical indications for TEA. Methods A systematic review of PubMed and EMBASE databases was conducted. Case series and comparative studies reporting results after three types of primary TEA were eligible for inclusion. Results Forty-nine eligible studies were identified ( n = 1995). The number of TEA cases published annually increased from 6 cases in 1980 to 135 cases in 2008. The commonest indication for TEA throughout the review period was rheumatoid arthritis but its annual proportion reduced from 77% to 50%. The mean Mayo Elbow Performance Score significantly improved for all indications. Three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the trauma sequelae group. Complication and revision rates varied; rheumatoid arthritis 5.2–30.9% and 11–13%, acute fracture 0–50% and 10–11%, trauma sequelae 14.2–50% and 0–30%, osteoarthritis 50% and 11%, respectively. Discussion TEA can provide functional improvements in inflammatory arthritis, acute fractures, trauma sequelae and miscellaneous indications. Long-term TEA survivorship appears satisfactory in rheumatoid arthritis and fracture cases; however, further research into alternative surgical indications is still required.

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Total elbow arthroplasty for end-stage rheumatoid elbow arthritis with major instability: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203735 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1090

Author(s):

Diogo A. Sousa ◽

Rita Sapage ◽

Carlos Branco ◽

Rita Sousa ◽

Joao Reis ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Case Report ◽

Range Of Motion ◽

Severe Pain ◽

Daily Activities ◽

Total Elbow Arthroplasty ◽

Elbow Arthroplasty ◽

Active Range Of Motion ◽

End Stage

<p>A 73 years old female diagnosed with rheumatoid arthritis for over 30 years with an end-stage right elbow arthritis (stage V of Larsen’s classification) with a major instability. The patient presented gross deformity and severe pain with critical limitation of limb function. The patient was treated with a total elbow arthroplasty with an intraoperative olecranon fracture. At six months follow up, the patient presents with an excellent active range of motion and painless joint, without daily activities limitation.</p>

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Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

Orthopedic Reviews ◽

10.4081/or.2016.6211 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Andreas Panagopoulos ◽

Irini Tatani ◽

Dimitrios Ntourantonis ◽

Ioannis Seferlis ◽

Antonis Kouzelis ◽

...

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Proximal Humerus ◽

Constant Score ◽

Surgical Techniques ◽

Case Series ◽

Cochrane Library ◽

Operation Rate ◽

Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

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Total Elbow Arthroplasty in Rheumatoid Arthritis and Other Inflammatory Conditions: Unlinked or Linked Replacement?

Elbow Arthroplasty ◽

10.1007/978-3-030-14455-5_9 ◽

2019 ◽

pp. 115-124

Author(s):

Alessandra Colozza ◽

Luigi Perna ◽

Alberto Trimarchi ◽

Bernard F. Morrey

Keyword(s):

Rheumatoid Arthritis ◽

Total Elbow Arthroplasty ◽

Elbow Arthroplasty ◽

Inflammatory Conditions

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Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1736570 ◽

2021 ◽

Vol 49 (02) ◽

pp. e97-e104

Author(s):

Ignacio Miranda ◽

Francisco J. Lucas ◽

Vicente Carratalá ◽

Joan Ferràs-Tarragó ◽

Francisco J. Miranda

Keyword(s):

Systematic Review ◽

Surgical Techniques ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Anatomic Reconstruction ◽

Wrist Arthroscopy ◽

Radioulnar Joint ◽

Druj Instability ◽

Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

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