Welsink Chantal L, Lambers Kaj T A, van Deurzen Derek F P, Eygendaal Denise, van den Bekerom Michel P J
Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
Department of Orthopaedic Surgery, Academisch Medisch Centrum, Amsterdam, the Netherlands.
JBJS Rev. 2017 Jul;5(7):e4. doi: 10.2106/JBJS.RVW.16.00089.
Most total elbow arthroplasty (TEA) designs aim to replicate anatomy and provide stability in the treatment of the degenerative elbow joint. Given the promising results that have been reported following the use of TEA for the treatment of complex fractures, the indications for this procedure are growing. The objective of the present study was to review the most recent literature on the results of the most commonly performed TEAs.
A comprehensive literature search was conducted. All relevant studies were reviewed according to a set of predefined inclusion and exclusion criteria. After the initial assessment, 2 authors extracted data from the included articles. Groups were created on the basis of the design of TEA implant, the type of implant (linked or unlinked), and the indication for treatment. Outcome parameters were survival rate, pain, range of motion, complications, and specific elbow outcome scores.
Seventy-three articles involving a total of 9,379 TEAs were included. The level of evidence was primarily Level IV. Nineteen specific designs of TEA implants were described, including the Souter-Strathclyde (n = 2,387), Coonrad-Morrey (n = 1,586), Kudo (n = 560), and GSB III (n = 498). The most common indication for TEA was rheumatoid arthritis (70%). The weighted mean survival rate for the linked and unlinked prostheses was 85.5% at 7.8 years and 74% at 12.3 years, respectively. For the Coonrad-Morrey, Souter-Strathclyde, and GSB III, the weighted mean survival rate was 87.2% at 7.2 years, 70.6% at 14.2 years, and 81.7% at 9.5 years, respectively. The range of motion after TEA was good overall, with a mean flexion angle of 129° and a mean extension lag angle of 30°. The complication rates ranged from 11% to 38%, with clinical loosening being the most frequently reported complication (7%).
The results of TEA are respectable overall. It appears that there are small differences between designs. However, despite the fairly good functional results and elbow scores, the survival and complication rates are still not as favorable as those following arthroplasties in other joints.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
大多数全肘关节置换术（TEA）设计旨在复制解剖结构，并为退行性肘关节的治疗提供稳定性。鉴于使用TEA治疗复杂骨折后已报道的令人鼓舞的结果，该手术的适应证正在增加。本研究的目的是回顾关于最常用TEA手术结果的最新文献。
进行了全面的文献检索。所有相关研究均根据一组预先定义的纳入和排除标准进行审查。初步评估后，两名作者从纳入的文章中提取数据。根据TEA植入物的设计、植入物类型（链接或非链接）以及治疗适应证进行分组。结果参数包括生存率、疼痛、活动范围、并发症以及特定的肘关节结果评分。
纳入了73篇涉及总共9379例TEA的文章。证据水平主要为IV级。描述了19种特定的TEA植入物设计，包括Souter-Strathclyde（n = 2387）、Coonrad-Morrey（n = 1586）、Kudo（n = 560）和GSB III（n = 498）。TEA最常见的适应证是类风湿性关节炎（70%）。链接和非链接假体的加权平均生存率在7.8年时分别为85.5%，在12.3年时分别为74%。对于Coonrad-Morrey、Souter-Strathclyde和GSB III，加权平均生存率在7.2年时分别为87.2%，在14.2年时分别为70.6%，在9.5年时分别为81.7%。TEA后的活动范围总体良好，平均屈曲角度为129°，平均伸展滞后角度为30°。并发症发生率在11%至38%之间，临床松动是最常报告的并发症（7%）。
TEA的总体结果是可观的。不同设计之间似乎存在细微差异。然而，尽管功能结果和肘关节评分相当不错，但生存率和并发症发生率仍不如其他关节置换术后的情况理想。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
