Increase in volume of total elbow arthroplasty procedures found among fracture patients
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Results showed a notable increase in the volume of total elbow arthroplasty performed from 2009 to 2018, with a large proportion of total elbow arthroplasties performed for fracture and high rates of readmission and ED utilization.
David W. Zeltser, MD, Ronald A. Navarro, MD, and colleagues collected characteristics and demographics of 172 patients who underwent primary unilateral total elbow arthroplasty from January 2009 and March 2018, and calculated crude 90-day postoperative incidence rates for ED visits, readmission and mortality. Researchers also calculated cumulative revision and reoperation probabilities.
Results showed the total elbow arthroplasty annual procedure volume doubled from 11 to 22 procedures from 2009 to 2017. Researchers found patients who underwent total elbow arthroplasty had a mean age of 68.3 years, with 7.6% of patients younger than 50 years of age and a mean BMI of 27.1 kg/m2. Researchers also noted 82% of patients were female, 88.6% did not have diabetes and 52.5% had an American Society of Anesthesiologist classification of 1 or 2. Total elbow arthroplasty was performed for traumatic indications in 41.3% of cases, according to results.
“We are seeing a consistent trend in recent years toward increasing utilization of [total elbow arthroplasty] TEA for treatment of fracture and decreasing use for rheumatoid arthritis,” Zeltser told Healio Orthopedics.
Researchers found 25% of patients who underwent total elbow arthroplasty had a 90-day ED visit, 14% had a 90-day readmission and 1.2% died within 90 days postoperatively. Results showed a crude 3-year cumulative revision probability following total elbow arthroplasty of 9.1%. The median time from total elbow arthroplasty to revision was 1.4 years among patients who underwent a revision surgery, according to results.
“This study lays the groundwork for further investigation into risk factors for revision and ED utilization postoperatively,” Navarro told Healio Orthopedics. – by Casey Tingle
Reference:
Zeltser DW, et al. ePaper 522. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosures: Zeltser reports no relevant financial disclosures. Navarro reports he is a board or committee member for the American Academy of Orthopaedic Surgeons, the American Board of Orthopaedic Surgery Inc., the American Orthopaedic Association, the American Shoulder and Elbow Surgeons and the California Orthopaedic Association.
Perspective
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Michael R. Hausman, MD
Enthusiasm for total elbow arthroplasty is a function of the patient and surgeon's innate optimism. Unfortunately, it may be a race to failure and the only uncertainty is whether total elbow arthroplasty failure or the patient’s demise occurs first. There are good indications, but as this study demonstrates, wider application to trauma-related problems and younger patients is fraught with complications and a substantial failure rate even over the relatively short follow-up period of 3.2 years.
We should choose our complications wisely. Failure of the primary total elbow arthroplasty is associated with a high incidence of subsequent revisions and the likelihood of infection and substantial bone loss. Complication rates of 20% to 40% are reported. The Norwegian Arthroplasty Register shows implant survival of 71% at 15 years and 61% at 20 years. Half of the implants done at age 65 [years] will fail by 85 [years], when the patient will need to rely on the arm for a cane or to simply rise from a chair. Fixing distal humerus fractures using contemporary, parallel plate constructs may be an alternative. Motion may be limited and not painless, but the outcomes are durable, if imperfect, with no unrealistic limitations on use. For now, I’ll choose that set of complications.
Reference:Voloshin I, et al. J Shoulder Elbow Surg. 2011;doi:10.1016/j.jse.2010.08.026.
Chief, upper extremity surgery
New York
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Zeltser DW, et al. ePaper 522. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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