Gold Coast University Hospital, Southport, QLD, Australia.
Barwon Centre of Orthopaedic Research and Education, Deakin University, Geelong, VIC, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia.
J Shoulder Elbow Surg. 2024 Feb;33(2):356-365. doi: 10.1016/j.jse.2023.08.001. Epub 2023 Sep 7.
Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates.
Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from May 2, 2005, to December 31, 2021, included all procedures for primary elbow replacement with primary diagnosis of fracture or dislocation. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models.
There were 293 primary HA and 631 primary TER procedures included. The cumulative percentage revision (CPR) rate at 9 years was 9.7% for HA (95% confidence interval [CI] 6.0, 15.7), and 11.9% (95% CI 8.5, 16.6) for TER. When adjusted for age and gender, there was a significantly higher risk of revision after 3 months for TER compared to HA (HR 2.47, 95% CI 1.22, 5.03, P = .012). There was no difference in the rate of revision for patients aged <55 years or ≥75 years when HA and TER procedures were compared. In primary TER procedures, loosening was the most common cause of revision (3.6% of primary TER procedures), and the most common type of revision in primary TER involved revision of the humeral component only (2.6% of TER procedures). TER has a higher rate of first revision for loosening compared to HA (HR 4.21, 95% CI 1.29, 13.73; P = .017). In HA procedures, instability (1.7%) was the most common cause for revision. The addition of an ulna component was the most common type of revision (2.4% of all HA procedures).
For the treatment of distal humerus fractures, HA had a lower revision rate than TER after 3 months when adjusted for age and gender. Age <55 or ≥75 years was not a risk factor for revision when HA was compared to TER. Loosening leading to revision is more prevalent in TER and increases with time. In HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component.
全肘关节置换术（TER）是治疗老年患者复杂关节内肱骨远端骨折的一种公认的治疗方法。肱骨远端半关节置换术（HA）也是不可重建骨折的潜在手术选择，并避免了与 TER 相关的机械磨损和功能限制的担忧。在当前文献中，比较 HA 和 TER 治疗骨折的翻修率的数据有限。我们使用来自大型国家关节置换登记处的数据，比较了 HA 和 TER 治疗骨折/脱位的结果，并评估了人口统计学和植入物选择对翻修率的影响。
数据来自澳大利亚矫形协会全国关节置换登记处，时间为 2005 年 5 月 2 日至 2021 年 12 月 31 日，包括所有因骨折或脱位而进行的原发性肘关节置换术的主要诊断。使用 Kaplan-Meier 生存估计和 Cox 比例风险模型的风险比（HR）进行分析。
共纳入 293 例原发性 HA 和 631 例原发性 TER 手术。HA 的 9 年累积翻修率（CPR）为 9.7%（95%置信区间 [CI]：6.0，15.7），TER 为 11.9%（95% CI：8.5，16.6）。调整年龄和性别后，TER 在 3 个月后翻修的风险明显高于 HA（HR 2.47，95% CI：1.22，5.03，P = 0.012）。在比较 HA 和 TER 手术时，<55 岁或≥75 岁的患者翻修率无差异。在原发性 TER 手术中，松动是最常见的翻修原因（3.6%的原发性 TER 手术），而原发性 TER 中最常见的翻修类型是仅更换肱骨组件（2.6%的 TER 手术）。TER 松动导致翻修的风险高于 HA（HR 4.21，95% CI：1.29，13.73；P = 0.017）。在 HA 手术中，不稳定（1.7%）是最常见的翻修原因。添加尺骨组件是最常见的翻修类型（占所有 HA 手术的 2.4%）。
在调整年龄和性别后，与 TER 相比，HA 在 3 个月后治疗肱骨远端骨折的翻修率较低。与 TER 相比，<55 岁或≥75 岁不是翻修的危险因素。TER 松动导致翻修的发生率较高，且随时间推移而增加。在 HA 中，最常见的翻修类型是添加尺骨组件，同时保留肱骨组件。
