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Humeral amputation following total elbow arthroplasty

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Abstract

Purpose

Total elbow arthroplasty (TEA) is associated with a relatively high complication rate, and exceptionally catastrophic complications might lead to amputation. The purpose of this study was to determine the incidence and aetiology of amputation performed at our institution in upper extremity limbs with a prior TEA.

Methods

Between 1973 and 2018, 1906 consecutive TEAs were performed at our institution. Upper extremity amputation was performed in seven (0.36%) elbows with five transhumeral amputations and two shoulder disarticulations. The group consisted of five females and two males with a mean age of 64 years (range, 37–80). The index TEA had been performed for rheumatoid arthritis (n = 2), rheumatoid arthritis with acute fracture (n = 2), radiation associated nonunion (n = 2), and metastatic cancer (n = 1). Mean follow-up after amputation was three years (range, 3 months–5 years).

Results

Mean time between amputation and TEA was 5 years (range, 2 months–13 years). The indications for amputation included uncontrolled deep infection in six (86%) elbows and tumor recurrence in one (14%) elbow. Only one elbow (14%) was fitted with a prosthesis. Six (86%) patients died at a mean of three years (range, 3 months–5 years) after amputation.

Conclusion

The results of this study highlight a low incidence of amputation after TEA. Most amputations were the direct result of TEA complications, with infection being the most common cause of amputation. Outcomes after amputation are concerning, with poor overall survival and few patients being fit for a prosthesis.

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Data availability

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Author information

Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, 200 First Street S.W, Rochester, MN, 55905, USA

    Matthew R. Claxton

  2. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA

    Matthew B. Shirley, Richard F. Nauert, Mark E. Morrey, Joaquin Sanchez-Sotelo & Matthew T. Houdek

Authors
  1. Matthew R. Claxton
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  2. Matthew B. Shirley
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  3. Richard F. Nauert
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  4. Mark E. Morrey
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  5. Joaquin Sanchez-Sotelo
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  6. Matthew T. Houdek
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Contributions

MRC: Data collection, data analysis, manuscript preparation and editing.

MBS: Data collection, data analysis, manuscript preparation and editing.

RFN: Data collection, data analysis, manuscript preparation and editing.

MEE: Manuscript preparation and editing.

JSS: Manuscript preparation and editing.

MTH: Data collection, data analysis, manuscript preparation and editing, supervision.

Corresponding author

Correspondence to Matthew T. Houdek.

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Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Conflict of interest

One author (JSS) is a consultant for Styker Orthopedics, Acumed, Exactech, and Wright Medical.

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Claxton, M.R., Shirley, M.B., Nauert, R.F. et al. Humeral amputation following total elbow arthroplasty. International Orthopaedics (SICOT) 45, 1281–1286 (2021). https://doi.org/10.1007/s00264-020-04906-1

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  • DOI: https://doi.org/10.1007/s00264-020-04906-1

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