Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital -NYU Langone Health, 333 East 38Th Street, New York, NY, 10016, USA.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2303-2308. doi: 10.1007/s00590-022-03425-6. Epub 2022 Nov 8.
The purpose of this study is to compare the 90 day complication rates of primary Total Elbow Arthroplasty (TEA) performed for arthritis (primary-OA; rheumatoid arthritis-RA) versus those performed for distal humerus fractures (DHF).
Patients who underwent a TEA from 2015 to 2021 were identified from our institutional database and placed into cohorts based on surgical indications (TEA-OA, TEA-RA and TEA-DHF). Chart review was conducted to analyze the prevalence of complications, emergency department (ED) visits, readmissions, and secondary procedures in the first 90 day post-operative period. Complications included but were not limited to wound complications, hematoma, infection (superficial or deep), nerve palsy, periprosthetic fracture/failure and others.
49 patients who underwent TEA were included in this study: (DHF = 19, OA = 14, RA = 16). Six complications occurred within the first 90 days of surgery. There were two periprosthetic joint infections (PJI) in the OA group, requiring irrigation and debridement (I & D) within the first 90 days of surgery. There were three post-operative ulnar nerve palsies and one PJI requiring I & D in the TEA-RA group. Compared to the TEA-DHF and TEA-OA groups, the RA group had higher rates of all-cause complications (p = 0.03) and nerve palsy (p = 0.03). There were no significant differences between groups in readmissions (p = 0.27) or secondary interventions (p = 0.27).
The 90-day complication/readmission rates of TEA preformed for DHFs is lower than those preformed for OA and RA. These differences could be related to the underlying chronic inflammatory etiology and side effect of treatments (intraarticular steroid injection, and biologics) received by patients with arthritis.
Retrospective Cohort Study, level IV.
本研究旨在比较因关节炎（原发性骨关节炎；类风湿关节炎）和肱骨远端骨折（DHF）而行初次全肘置换术（TEA）的 90 天并发症发生率。
从我院数据库中确定 2015 年至 2021 年期间行 TEA 的患者，并根据手术指征（TEA-OA、TEA-RA 和 TEA-DHF）将患者分为不同队列。通过病历回顾分析术后 90 天内并发症、急诊就诊、再入院和二次手术的发生率。并发症包括但不限于伤口并发症、血肿、感染（浅部或深部）、神经麻痹、假体周围骨折/失败和其他。
本研究共纳入 49 例行 TEA 的患者：（DHF=19，OA=14，RA=16）。6 例患者在术后 90 天内发生并发症。OA 组有 2 例假体周围关节感染（PJI），需要在术后 90 天内进行灌洗和清创术（I&D）。TEA-RA 组有 3 例术后尺神经麻痹和 1 例 PJI 需要 I&D。与 TEA-DHF 和 TEA-OA 组相比，RA 组的总并发症发生率（p=0.03）和神经麻痹发生率（p=0.03）更高。各组间再入院率（p=0.27）和二次干预率（p=0.27）无显著差异。
因 DHF 而行 TEA 的 90 天并发症/再入院率低于因 OA 和 RA 而行 TEA。这些差异可能与关节炎患者接受的潜在慢性炎症病因和治疗（关节内类固醇注射和生物制剂）的副作用有关。
回顾性队列研究，IV 级。
