Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008.
BACKGROUND
Total elbow arthroplasty (TEA) is an established treatment for late-stage arthritis of the elbow. Indications have expanded to osteoarthritis and nonunion in distal humeral fractures. Information on implant survival and risk factors for revision is still sparse. The aim of this study was to evaluate implant survival and risk factors for revision of TEAs inserted in patients in the eastern part of Denmark in the period from 1980 until 2008.


METHODS
The Danish National Patient Register provided personal identification numbers for patients who underwent TEA procedures from 1980 until 2008. On the basis of a review of medical reports and linkage to the National Patient Register, we calculated revision rates and evaluated potential risk factors for revision, including, age, sex, period, indication for TEA, and implant design.


RESULTS
We evaluated 324 primary TEA procedures in 234 patients at a mean follow-up of 8.7 years (range, 0-27 years). The overall 5-year survival was 90% (95% confidence interval [CI], 88%-94%), and 10-year survival was 81% (95% CI, 76%-86%). TEAs performed with the unlinked design had a relative risk of revision of 1.9 (95% CI, 1.1-3.2) compared with the linked design. Fracture sequelae was associated with a relative risk of revision of 1.9 (95% CI, 1.05-3.45).


CONCLUSIONS
We found acceptable implant survival rates after 5 and 10 years, with a higher revision rate for the unlinked design and primary TEA due to fracture sequelae. Patient-related outcome measures should be included in future studies for further elaboration of the outcomes after TEA.


METHODS
Level III, Retrospective cohort design, treatment study.
Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Copenhagen University Hospital, Herlev, Denmark. Electronic address: hcplaschke@dadlnet.dk.
Hans Christian
HC
Plaschke
Department of Orthopedic Surgery, Horsens Regional Hospital and Aarhus University Hospital, Horsens, Denmark.
Theis M
TM
Thillemann
Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Copenhagen University Hospital, Herlev, Denmark.
Stig
S
Brorson
Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Copenhagen University Hospital, Herlev, Denmark.
Bo S
BS
Olsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000706:statistics & numerical data; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries
Total elbow arthroplasty; arthroplasty; elbow; elbow fracture; elbow release; joint replacement; prosthesis; rheumatoid arthritis