Long-term outcomes of total elbow arthroplasty for distal humeral fracture: results from a prior randomized clinical trial.
Aged
Aged, 80 and over
Arthralgia
/ etiology
Arthroplasty, Replacement, Elbow
Elbow Joint
/ surgery
Elbow Prosthesis
Female
Follow-Up Studies
Fracture Fixation, Internal
Fractures, Comminuted
/ surgery
Humans
Humeral Fractures
/ surgery
Intra-Articular Fractures
/ surgery
Male
Multicenter Studies as Topic
Open Fracture Reduction
Prosthesis Failure
Randomized Controlled Trials as Topic
Reoperation
/ statistics & numerical data
Retrospective Studies
Time Factors
Treatment Outcome
Total elbow arthroplasty
distal humeral fracture
geriatric fracture
open reduction–internal fixation
osteoporotic fracture
Journal
Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
06
11
2018
revised:
04
06
2019
accepted:
07
06
2019
pubmed:
26
8
2019
medline:
18
1
2020
entrez:
26
8
2019
Statut:
ppublish
Résumé
Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture. Patients from a previously published randomized controlled trial of 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival. Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up. TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.
Sections du résumé
BACKGROUND
BACKGROUND
Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture.
METHODS
METHODS
Patients from a previously published randomized controlled trial of 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival.
RESULTS
RESULTS
Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up.
CONCLUSIONS
CONCLUSIONS
TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.
Identifiants
pubmed: 31445787
pii: S1058-2746(19)30419-7
doi: 10.1016/j.jse.2019.06.004
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2198-2204Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.