Total elbow arthroplasty in bleeding disorders: an additional series of 8 cases.
BACKGROUND
Total elbow arthroplasty (TEA) is a surgical option for an arthropathy secondary to a bleeding disorder. The literature consists of small case series. Our series provides further understanding into the outcomes of TEA in this population of patients.


METHODS
Five patients underwent 8 primary TEAs for a bleeding disorder. Average age at time of surgery was 47 years. Four patients had hemophilia type A and 1 had von Willebrand disease. Clinical outcomes were evaluated with the Mayo Elbow Performance Score (MEPS) and the visual analog scale (VAS) for pain. Follow-up radiographs were evaluated for signs of loosening and infection.


RESULTS
Revision surgery was performed in 3 TEAs. Two revisions were performed for aseptic loosening (104 and 118 months postoperatively). The third elbow underwent an excision arthroplasty for a deep infection 44 months postoperatively. Mean follow-up for the primary TEAs still in situ (5 elbows) was 114 months. The mean VAS score improved from 8 to 0 and MEPS from 35 to 95. The mean flexion arc improved from 70° to 100°, and rotation improved from 60° to 160°. Mean follow-up for the revised TEAs (3 elbows) was 94 months. The mean VAS score improved from 7 to 0 and the MEPS from 40 to 85. The mean flexion arc improved from 60° to 95°, and rotation improved from 70° to 160°.


CONCLUSIONS
Excellent clinical outcomes and an acceptable survival rate for TEAs, comparable with the nonhemorrhagic population, can be achieved in patients with bleeding disorders. Revision arthroplasty in this group of patients yields good clinical outcomes at medium-term follow-up.
Centre for Orthopaedic Surgery OCON, Upper Extermity Unit, Hengelo, The Netherlands.
Anne J
AJ
Vochteloo
Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
Stephen J
SJ
Roche
Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
Robert P
RP
Dachs
Department of Orthopaedic Surgery, University of Cape Town and Life Orthopaedic Hospital, Cape Town, South Africa. Electronic address: basil@shoulderelbow.co.za.
Basil C
BC
Vrettos
D000328:Adult; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058569:Elbow Prosthesis / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011475:Prosthesis Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000209:etiology*; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000150:complications*
Total elbow arthroplasty; arthropathy; bleeding disorders; case series; elbow; hemophilia; revision