Results after 562 total elbow replacements: A report from Norwegian Arthroplasty Register

Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.29). 05/2009; 18(3):449-56. DOI: 10.1016/j.jse.2009.02.020
Source: PubMed

ABSTRACT The aim of this study was to give results of elbow arthroplasty for a relatively large population and compare different prosthesis brands and different patient subgroups.
Between 1994 and 2006, 562 total elbow replacement operations were reported to the Norwegian Arthroplasty Register. Revisions of prostheses were shown using Kaplan-Meier failure curves, and risk of revision was calculated using Cox regression analysis.
The overall 5- and 10-year failure rates were 8% and 15%, respectively. There were only minor differences between the different implants. Patients who developed traumatic arthritis after fracture had the worst prognosis compared with inflammatory arthritis (P = .005). Risk of revision was also increased when the ulnar component was inserted without cement (P = .02.)
Good results in terms of prosthesis survival were obtained with total elbow arthroplasty, although results were worse than for knee- and hip arthroplasties. The best results were achieved in patients with inflammatory arthritis.

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Available from: Ove Furnes, Sep 29, 2015
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    • "Even so, implant survival would be expected to decrease in the years to come. Even if the implant survival curve would decline after 9 years, the implant survival in our series is still comparable to the implant survival after total elbow arthroplasty and total ankle arthroplasty, which are more commonly used and less debatable procedures (Fevang et al. 2007, 2009, Skytta et al. 2009, 2010). "
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    ABSTRACT: Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007. The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier generations of total wrist arthroplasty.
    Acta Orthopaedica 07/2013; 84(4). DOI:10.3109/17453674.2013.823588 · 2.77 Impact Factor
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    • "A recent systematic review reported that TER for posttraumatic complications had the highest complication rate of 38%, compared to 24% for inflammatory arthritis (Voloshin et al. 2011). This is in keeping with other case series (Fevang et al. 2009, Morrey and Schneeberger 2009). "
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    ABSTRACT: Background and purpose Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications. Methodology We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship. Results There were 1,146 primary TER procedures (incidence: 1.4 per 105 population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = –0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year. Interpretation The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty.
    Acta Orthopaedica 03/2013; 84(2). DOI:10.3109/17453674.2013.784658 · 2.77 Impact Factor
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    • "Replacement arthroplasty of the elbow is in constant evolution. Although it was initially used mainly in patients with inflammatory arthritis, its indications were expanded to other conditions, which place higher demands on the implants and seem to lead to higher failure rates [1]. Elbow arthroplasty presents some unique peculiarities. "
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    ABSTRACT: Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications. Inflammatory arthropathies such as rheumatoid arthritis represent the classic indication for elbow arthroplasty. Indications have been expanded to include posttraumatic osteoarthritis, acute distal humerus fractures, distal humerus nonunions and reconstruction after tumor resection. Elbow arthroplasty is very successful in terms of pain relief, motion and function. However, its complication rate remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures, worse for patients with posttraumatic osteoarthritis. The most common complications of elbow arthroplasty include infection, loosening, wear, triceps weakness and ulnar neuropathy. When revision surgery becomes necessary, bone augmentation techniques provide a reasonable outcome.
    The Open Orthopaedics Journal 03/2011; 5(1):115-23. DOI:10.2174/1874325001105010115
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