Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands.
Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands.
J Shoulder Elbow Surg. 2019 Feb;28(2):381-386. doi: 10.1016/j.jse.2018.08.024.
Although revision arthroplasty surgery is a frequently used treatment for failed total elbow arthroplasty (TEA), published results are conflicting. The aim of this systematic review was to provide an overview of the outcomes of revision TEA surgery.
A systematic literature search was performed in major databases to find articles relating to outcomes after revision of TEA. Two reviewers independently screened the articles for inclusion, and a third reviewer screened them before final inclusion.
Twenty-one articles containing 532 cases were included. The mean age at revision was 61 years. The mean interval between primary and revision arthroplasty was 77 months, and the average follow-up period was 65 months. Different types of prostheses were included, with 69% of the revision prostheses having linked designs and 31% having unlinked designs. The visual analog scale score, Mayo Elbow Performance Score, Oxford Elbow Score, and range of motion improved significantly after revision surgery. Complications were reported in 232 of 532 cases (44%), leading to reoperations in 22%. After revision with linked prostheses, the Mayo Elbow Performance Score, range of flexion-extension, and pronation improved significantly more than with unlinked designs.
Improved functional outcomes can be expected after revision TEA, but the complication rate remains high. Revision TEA should still be considered a salvage procedure for failed TEA. Linked designs for revision TEA result in better outcomes than unlinked designs in the midterm follow-up.
尽管翻修关节成形术是治疗全肘人工关节置换失败的常用方法，但已发表的结果存在争议。本系统评价的目的是提供全肘人工关节翻修术后结果的概述。
在主要数据库中进行了系统的文献检索，以找到与全肘人工关节翻修后结果相关的文章。两名评审员独立筛选文章是否纳入，在最终纳入前，第三名评审员进行筛选。
共纳入 21 篇文章，包含 532 例。翻修时的平均年龄为 61 岁。初次置换和翻修之间的平均间隔为 77 个月，平均随访时间为 65 个月。纳入了不同类型的假体，其中 69%的翻修假体为连接式设计，31%为非连接式设计。视觉模拟评分、梅奥肘关节功能评分、牛津肘关节评分和活动范围在翻修手术后均显著改善。532 例中有 232 例（44%）报告了并发症，导致 22 例再次手术。与非连接式设计相比，采用连接式假体进行翻修后，梅奥肘关节功能评分、屈伸活动范围和旋前活动度的改善更为显著。
全肘人工关节翻修后可预期获得更好的功能结果，但并发症发生率仍然较高。全肘人工关节翻修仍应被视为治疗失败的全肘人工关节的挽救性手术。在中期随访中，与非连接式设计相比，翻修用连接式假体可获得更好的结果。
