Department of Orthopaedic Surgery, Reinier de Graaf, Delft, the Netherlands.
Sint Maartenskliniek Research, Nijmegen, the Netherlands.
J Shoulder Elbow Surg. 2020 Jan;29(1):126-131. doi: 10.1016/j.jse.2019.07.023. Epub 2019 Sep 26.
Aseptic loosening is a main concern in elbow arthroplasty. Evaluation of implant migration using radiostereometric analysis (RSA) might increase understanding of implant loosening. Previously, 2-year RSA results of 16 Instrumented Bone Preserving (IBP) elbow prostheses showed migration of the humeral component in the first weeks but most components stabilized within 6 months postoperatively. In follow-up, the present study evaluated long-term survival, the relation between early migration and survival, and the long-term migration and clinical outcomes.
Sixteen patients who received an IBP prosthesis were prospectively followed with a median follow-up time of 136 months (range 82-165). Migration was measured using RSA. Clinical results were described using the Elbow Function Assessment (EFA), Broberg and Morrey elbow functional rating index, Oxford Elbow Score (OES), and visual analog scale (VAS) for pain and satisfaction.
Four patients underwent a revision within 10 years, and 2 more were planned for revision surgery after 14 years. Five patients died with their prosthesis in situ. Early migration was not associated with survival. Long-term migration patterns varied widely. Median EFA score was 58.5, Broberg and Morrey score was 50, and OES score was 32. Median VAS score for pain was 2 and that for satisfaction was 7.5.
Ten-year survival of the IBP total elbow prosthesis was 75%, decreasing to 63% after 14 years of follow-up. Long-term implant failure could not be predicted by 2-year migration results in this study. Although short-term clinical results were promising, long-term outcomes worsened in all patients.
无菌性松动是肘部关节置换术的主要关注点。使用放射立体测量分析（RSA）评估植入物迁移可能会增加对植入物松动的理解。此前，16 例 Instrumented Bone Preserving（IBP）肘部假体的 2 年 RSA 结果显示肱骨部件在最初几周内发生迁移，但大多数部件在术后 6 个月内稳定。在随访中，本研究评估了长期生存率、早期迁移与生存率的关系以及长期迁移与临床结果的关系。
16 例接受 IBP 假体的患者前瞻性随访，中位随访时间为 136 个月（范围 82-165）。使用 RSA 测量迁移。临床结果采用肘部功能评估（EFA）、Broberg 和 Morrey 肘部功能评分指数、牛津肘部评分（OES）和视觉模拟评分（VAS）进行疼痛和满意度描述。
4 例患者在 10 年内接受了翻修手术，另外 2 例在 14 年后计划接受翻修手术。5 例患者死亡，假体仍在位。早期迁移与生存率无关。长期迁移模式差异很大。EFA 评分中位数为 58.5，Broberg 和 Morrey 评分为 50，OES 评分为 32。疼痛 VAS 评分中位数为 2，满意度 VAS 评分为 7.5。
IBP 全肘假体的 10 年生存率为 75%，14 年随访后降至 63%。本研究中，2 年的迁移结果不能预测长期植入物失效。尽管短期临床结果有希望，但所有患者的长期结果都恶化了。
