Department of Orthopedic and Trauma Surgery, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia.
Shoulder and Elbow Unit, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Acta Orthop. 2019 Dec;90(6):511-516. doi: 10.1080/17453674.2019.1657342. Epub 2019 Aug 27.
Background and purpose - The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) was analyzed to determine trends in use of primary total elbow arthroplasty (TEA), the types of prostheses used, primary diagnoses, reasons for and types of revision, and whether the primary diagnosis or prosthesis design influenced the revision rate.Patients and methods - During 2008-2018, 1,220 primary TEA procedures were reported of which 140 TEAs were revised. Kaplan-Meier estimates of survivorship were used to describe the time to first revision and hazard ratios (HR) from Cox proportional hazard models, adjusted for age and sex, were used to compare revision rates.Results - The annual number of TEAs performed remained constant. The 3 most common diagnoses for primary TEA were fracture/dislocation (trauma) (36%), osteoarthritis (OA) (34%), and rheumatoid arthritis (RA) (26%). The cumulative percentage revision for all TEAs undertaken for any reason was 10%, 15%, and 19% at 3, 6, and 9 years. TEAs undertaken for OA had a higher revision rate compared with TEAs for trauma (HR = 1.8, 95% CI 1.1-3.0) and RA (HR = 2.0, CI 1.3-3.1). The Coonrad-Morrey (50%), Latitude (30%), Nexel (10%), and Discovery (9%) were the most used prosthesis designs. There was no difference in revision rates when these 4 designs were compared. The most common reasons for revision were infection (35%) and aseptic loosening (34%).Interpretation - The indications for primary and revision TEA in Australia are similar to those reported for other registries. Revision for trauma is lower than previously reported.
背景与目的 - 对澳大利亚矫形协会全国关节置换登记处(AOANJRR)进行分析,以确定初次全肘置换术(TEA)的使用趋势、使用的假体类型、初次诊断、翻修的原因和类型,以及初次诊断或假体设计是否影响翻修率。
患者和方法 - 在 2008 年至 2018 年期间,报告了 1220 例初次 TEA 手术,其中 140 例进行了翻修。使用 Kaplan-Meier 估计来描述首次翻修的时间,并使用 Cox 比例风险模型调整年龄和性别因素后的风险比(HR)来比较翻修率。
结果 - 每年进行的 TEA 数量保持不变。初次 TEA 的 3 种最常见诊断为骨折/脱位(创伤)(36%)、骨关节炎(OA)(34%)和类风湿关节炎(RA)(26%)。因任何原因进行的所有 TEA 的累计翻修百分比分别为 3 年、6 年和 9 年时的 10%、15%和 19%。与创伤(HR=1.8,95%CI 1.1-3.0)和 RA(HR=2.0,CI 1.3-3.1)相比,OA 接受 TEA 的翻修率更高。Coonrad-Morrey(50%)、Latitude(30%)、Nexel(10%)和 Discovery(9%)是使用最多的假体设计。当比较这 4 种设计时,翻修率没有差异。翻修的最常见原因是感染(35%)和无菌性松动(34%)。
解释 - 澳大利亚初次和翻修 TEA 的适应证与其他登记处报告的相似。创伤后的翻修率低于先前报道的。