Vannabouathong Christopher, Venugopal Nainika, Athwal George S, Moro Jaydeep, Bhandari Mohit
OrthoEvidence, Burlington, ON, Canada.
McMaster University, Hamilton, ON, Canada.
JSES Int. 2020 Feb 29;4(1):30-38. doi: 10.1016/j.jseint.2019.11.003. eCollection 2020 Mar.
Numerous fixed-stem implants exist for radial head arthroplasty; therefore, we conducted a systematic review to compare the safety and efficacy of different types of fixed-stem implants.
We conducted a literature search, updated from a previous systematic review, to identify studies evaluating a fixed-stem radial head arthroplasty implant for any indication. We extracted data on revision rates, specific complications, and functional scores. We pooled results across studies using a random-effects method, using proportions for dichotomous data and mean values for functional scores. We analyzed outcomes by indication and specific implant.
We included 31 studies. Studies included patients with radial head fractures only, terrible-triad injuries, or Essex-Lopresti injuries or included a heterogeneous population. We identified 15 different fixed-stem implants. The results of our analysis revealed that patients with terrible-triad injuries may be at an increased risk of revision and instability and patients with Essex-Lopresti injuries may be at an increased risk of arthritis, capitellar erosion, and osteolysis. After removing these outliers and pooling the results by specific device, we observed variability across devices in the rates of revision, arthritis, capitellar erosion, instability, and osteolysis, as well as in functional scores.
Differences were seen across different implants in revision rates, certain complications, and functional scores. This study highlighted that these devices should be evaluated within the context of the patient population under examination, as patients with Essex-Lopresti or terrible-triad injuries may demonstrate worse outcomes relative to those with a fracture only.
桡骨头置换术有多种固定柄植入物；因此，我们进行了一项系统评价，以比较不同类型固定柄植入物的安全性和有效性。
我们进行了文献检索，在之前系统评价的基础上进行更新，以确定评估用于任何适应证的固定柄桡骨头置换植入物的研究。我们提取了翻修率、特定并发症和功能评分的数据。我们使用随机效应方法汇总各研究的结果，二分数据用比例，功能评分用均值。我们按适应证和特定植入物分析结果。
我们纳入了31项研究。这些研究纳入的患者仅患有桡骨头骨折、可怕三联征损伤或埃塞克斯-洛普雷斯蒂损伤，或纳入了异质性人群。我们确定了15种不同的固定柄植入物。我们的分析结果显示，患有可怕三联征损伤的患者翻修和不稳定风险可能增加，患有埃塞克斯-洛普雷斯蒂损伤的患者关节炎、肱骨小头侵蚀和骨溶解风险可能增加。去除这些异常值并按特定器械汇总结果后，我们观察到不同器械在翻修率、关节炎、肱骨小头侵蚀、不稳定和骨溶解发生率以及功能评分方面存在差异。
不同植入物在翻修率、某些并发症和功能评分方面存在差异。本研究强调，应在受检患者群体的背景下评估这些器械，因为与仅骨折患者相比，患有埃塞克斯-洛普雷斯蒂或可怕三联征损伤的患者可能预后更差。
