Journal article
Long-term results of total elbow arthroplasty in patients with hemophilia.
- Ernstbrunner L Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria. Electronic address: lukas.ernstbrunner@alumni.pmu.ac.at.
- Hingsammer A Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
- Imam MA Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Wrightington Hospital, Wigan, UK.
- Sutter R Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
- Brand B Department of Hematology, University Hospital Zürich, Zürich, Switzerland.
- Meyer DC Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
- Wieser K Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
- 2017-11-07
Published in:
- Journal of shoulder and elbow surgery. - 2018
Hemophilia
elbow
hemophilic arthropathy
joint replacement
long-term
total elbow arthroplasty
Adult
Aged
Arthritis
Arthroplasty, Replacement, Elbow
Elbow Joint
Female
Hemophilia A
Hemophilia B
Humans
Male
Middle Aged
Postoperative Complications
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
English
HYPOTHESIS
It was hypothesized that the long-term survivorship and clinical outcome are reasonable, justifying total elbow arthroplasty (TEA) in patients with end-stage hemophilic arthropathy.
METHODS
From 2002 to 2012, 13 primary TEAs (Coonrad-Morrey design) were implanted in 9 consecutive patients with an average age of 55 (range, 39-76) years. Type A hemophilia was diagnosed in 7 patients and type B hemophilia in 2 patients. Clinical and radiographic results of all (11 TEAs) but 1 patient were retrospectively analyzed.
RESULTS
After a mean of 9.1 (range, 5-14) years, the mean visual analog scale score for pain, total Mayo Elbow Performance Score, and subjective elbow value were significantly improved from 5 (standard deviation, ±3) to 2 (±2; P = .007) points, from 64 (±16) to 89 (±11; P = .008) points, and from 47% (±15%) to 81% (±11%; P < .001), respectively. Whereas the flexion arc remained unchanged (P = .279), mean active pronation improved significantly (P = .024). Postoperative complications were recorded in 8 TEAs (62%), whereas 5 TEAs (38%) underwent partial component exchange after a mean of 7.2 (range, 3-10) years: 2 for periprosthetic infection, 2 for polyethylene wear, and 1 for humeral component loosening. Of the living patients after partial component exchange (n = 3), the mean final total Mayo Elbow Performance Score, flexion and rotation arc, visual analog scale score for pain, and subjective elbow value were comparable with the results of the living patients without revision surgery (n = 8).
CONCLUSIONS
TEA for patients with advanced hemophilic arthropathy is associated with a substantial complication and revision rate. However, even after revision without implant removal, it provides good functional and subjective long-term results.
It was hypothesized that the long-term survivorship and clinical outcome are reasonable, justifying total elbow arthroplasty (TEA) in patients with end-stage hemophilic arthropathy.
METHODS
From 2002 to 2012, 13 primary TEAs (Coonrad-Morrey design) were implanted in 9 consecutive patients with an average age of 55 (range, 39-76) years. Type A hemophilia was diagnosed in 7 patients and type B hemophilia in 2 patients. Clinical and radiographic results of all (11 TEAs) but 1 patient were retrospectively analyzed.
RESULTS
After a mean of 9.1 (range, 5-14) years, the mean visual analog scale score for pain, total Mayo Elbow Performance Score, and subjective elbow value were significantly improved from 5 (standard deviation, ±3) to 2 (±2; P = .007) points, from 64 (±16) to 89 (±11; P = .008) points, and from 47% (±15%) to 81% (±11%; P < .001), respectively. Whereas the flexion arc remained unchanged (P = .279), mean active pronation improved significantly (P = .024). Postoperative complications were recorded in 8 TEAs (62%), whereas 5 TEAs (38%) underwent partial component exchange after a mean of 7.2 (range, 3-10) years: 2 for periprosthetic infection, 2 for polyethylene wear, and 1 for humeral component loosening. Of the living patients after partial component exchange (n = 3), the mean final total Mayo Elbow Performance Score, flexion and rotation arc, visual analog scale score for pain, and subjective elbow value were comparable with the results of the living patients without revision surgery (n = 8).
CONCLUSIONS
TEA for patients with advanced hemophilic arthropathy is associated with a substantial complication and revision rate. However, even after revision without implant removal, it provides good functional and subjective long-term results.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jse.2017.09.009
- PMID 29103812
- Persistent URL
- https://sonar.ch/global/documents/296950
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