Total elbow arthroplasty yielded high complication, revision rate among young patients
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Despite satisfactory results among younger patients who underwent total elbow arthroplasty, published results showed patients had a high rate of complications and revisions.
Researchers assessed the indication for further surgery, range of motion, mean Mayo Elbow Performance Score, QuickDASH score, radiolucent lines and outcomes measures that included implant survival, complications and revisions among 19 total elbow arthroplasties (Conrad-Morrey Total Elbow, Zimmer-Biomet) implanted in 17 patients younger than 55 years of age between 1998 and 2008.
At an average follow-up of 10 years, results showed a significant improvement in average range of motion from 120° to 140° for flexion and from 40° to 25° for extension. Researchers found patients had an average Mayo Elbow Performance Score of 85. Complications occurred in 56% of elbows, of which 42% underwent revision, according to results. Researchers noted aseptic loosening as the main indication for revision. Results showed a survivorship rate without revision of 94% at 5 years and of 75% at 10 years.
“[Total elbow arthroplasty] TEA should be considered with caution in younger patients,” the authors wrote. “Alternative therapeutic options must be discussed if possible.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Jay D. Keener, MD
The article “Outcomes of semi-constrained total elbow arthroplasty performed for arthritis in patients under 55 years old” provides valuable insight into the outcomes of elbow replacement in young patients. This retrospective series included 19 elbows that underwent arthroplasty due to either inflammatory or post-traumatic arthritis with a mean 10 years (range 2 years to 16 years) follow-up. The results demonstrate the reliability of elbow arthroplasty to produce good clinical outcomes with a mean postoperative Mayo Elbow Performance Score of 85 (range 55 to 100). However, 58% of elbows experienced significant complications and 42% underwent revision surgery. The most common reason for revision, predictably, was related to aseptic loosening.
This study underscores the challenges of treating elbow arthritis in young patients. Unfortunately, when end-stage joint destruction is present arthroplasty may seem the only viable option. The obvious concern of elbow replacement in young patients relates to long-term survivorship as demonstrated in multiple previous studies. Despite having a cohort of primarily patients with inflammatory arthritis, the need for revision surgery due to aseptic loosening (26%) remains alarmingly high at modest follow-up. This coupled with concerns for higher complication risks with revision surgery should temper the use of elbow arthroplasty in young patients except in the most severe cases.
Department of orthopedic surgery
St. Louis, Missouri
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