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Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty

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Abstract

Background

Total elbow arthroplasty (TEA) is considered a successful treatment for several conditions, including rheumatoid arthritis and comminuted fractures. However, failure rates as high as 62% have been reported, with many patients requiring surgical revision. Causes of failure requiring revision can be classified as infected or non-infected. This study evaluated the clinical and radiologic outcomes of TEA revision surgery according to causes of failure.

Methods

Twenty patients undergoing revision TEAs in 2010–2015 were retrospectively evaluated. Mean follow-up was 52.7 months. Patients were categorized into infected and non-infected groups based on radiologic and serologic tests. Clinical outcomes included range of motion (ROM) and Mayo Elbow Performance Score (MEPS), and radiological outcomes included loosening signs on anteroposterior (AP) and lateral plain radiographs at final follow-up. Complications were assessed in both groups.

Results

Overall, mean MEPS was 79.7, and mean ROM arc was 97.9° at final follow-up. Nine patients underwent revision due to infection, and 11 due to non-infectious causes. Mean MEPS in these two groups was 75.6 and 83.5, respectively, and mean ROM arc for flexion-extension was 89.4° and 108°, respectively. Two (22%) of the nine patients in the infection group required second revision surgery due to recurrent infection. No patient in the non-infected group underwent second revision surgery. The most frequent complication in the infected group was osteolysis, observed in five patients, including four with symptomatic aseptic loosening and one with non-symptomatic osteolysis. Two patients in the non-infected group demonstrated a non-progressive radiolucent line, which was asymptomatic at final follow-up.

Conclusion

Revision TEA provided clinical improvement in elbow function and resulted in satisfactory outcomes. Outcomes were worse in the infected than in the non-infected groups. Comorbidities and older age were apparent risk factors for infected TEA.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea

    Jae-Man Kwak, Yucheng Sun, Kyoung-Hwan Koh & In-Ho Jeon

  2. Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia

    Erica Kholinne

  3. Department of Orthopedic Surgery, Chonnam National University Hospital, Dong-gu, Kwangju, South Korea

    Myung-Sun Kim

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  1. Jae-Man Kwak
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  2. Erica Kholinne
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  3. Yucheng Sun
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  4. Myung-Sun Kim
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  5. Kyoung-Hwan Koh
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Correspondence to In-Ho Jeon.

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Level of evidence: III

This manuscript has not been published elsewhere and is not under consideration by another journal. We have approved the manuscript and agree with submission to the International Orthopaedics. There are no conflicts of interest to declare. Our study is approved by the Institutional Review Board.

This study was accepted as oral presentation in the 2018 Annual International Congress of Hand Society in Korea and 2018 SICOT congress in Montreal in Canada.

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Kwak, JM., Kholinne, E., Sun, Y. et al. Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty. International Orthopaedics (SICOT) 43, 1421–1427 (2019). https://doi.org/10.1007/s00264-018-4267-2

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  • DOI: https://doi.org/10.1007/s00264-018-4267-2

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