Abstract：
BACKGROUND: Aseptic loosening is one of the most common complications of total elbow arthroplasty (TEA). Modern implants, such as the Nexel, have been designed in an attempt to decrease loosening. The present study aims to report implant survivorship, radiographic assessment of loosening and lucency, and patient-reported outcome measures (PROMs) in patients treated with the Nexel TEA at midterm follow-up.
METHODS: Consecutive series of adult patients underwent TEA using the Nexel by a single surgeon via standardized technique. Patients with minimum 3-year follow-up with radiographic and PROM data were included. Survivorship was defined by the absence of revision. Loosening was assessed via the Wrightington method by 3 independent fellowship-trained shoulder and elbow surgeons. Lucency was analyzed across individual radiographic zones on orthogonal radiographs. PROMs included the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient-Rated Elbow Evaluation (PREE), and EuroQoL-5 Dimensions (EQ-5D).
RESULTS: Thirty-eight consecutive patients (22 female, 16 male) with a mean age of 67 years underwent TEA via a triceps-sparing isolated medial window approach. Mean follow-up was 5.5 years (range 3-9). Primary diagnoses were as follows: 19 osteoarthritis (OA), 9 rheumatoid arthritis (RA), 9 post-traumatic arthritis (PA), and 1 conversion of elbow arthrodesis. Overall survivorship was 97.4%, with 1 patient undergoing revision for infection. Loosening was found in 5.3% of elbows, averaged across 3 observers. Lucency was most pronounced at the level of the humeral condyles. PROMs demonstrated significant and clinically meaningful improvements in 76%, 92%, and 73% of patients for QuickDASH, PREE, and EQ-5D, respectively. No significant correlations were found between patient age, gender, loosening, lucency, and PROMs.
CONCLUSIONS: At midterm follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. The single failure requiring revision for infection was conversion of a prior elbow arthrodesis. PROMs overall exhibited marked and consistent improvement from preoperative to final postoperative follow-up. Although promising, these results should be interpreted with some caution as long-term data regarding this prosthesis are still lacking.
METHODS: Consecutive series of adult patients underwent TEA using the Nexel by a single surgeon via standardized technique. Patients with minimum 3-year follow-up with radiographic and PROM data were included. Survivorship was defined by the absence of revision. Loosening was assessed via the Wrightington method by 3 independent fellowship-trained shoulder and elbow surgeons. Lucency was analyzed across individual radiographic zones on orthogonal radiographs. PROMs included the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient-Rated Elbow Evaluation (PREE), and EuroQoL-5 Dimensions (EQ-5D).
RESULTS: Thirty-eight consecutive patients (22 female, 16 male) with a mean age of 67 years underwent TEA via a triceps-sparing isolated medial window approach. Mean follow-up was 5.5 years (range 3-9). Primary diagnoses were as follows: 19 osteoarthritis (OA), 9 rheumatoid arthritis (RA), 9 post-traumatic arthritis (PA), and 1 conversion of elbow arthrodesis. Overall survivorship was 97.4%, with 1 patient undergoing revision for infection. Loosening was found in 5.3% of elbows, averaged across 3 observers. Lucency was most pronounced at the level of the humeral condyles. PROMs demonstrated significant and clinically meaningful improvements in 76%, 92%, and 73% of patients for QuickDASH, PREE, and EQ-5D, respectively. No significant correlations were found between patient age, gender, loosening, lucency, and PROMs.
CONCLUSIONS: At midterm follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. The single failure requiring revision for infection was conversion of a prior elbow arthrodesis. PROMs overall exhibited marked and consistent improvement from preoperative to final postoperative follow-up. Although promising, these results should be interpreted with some caution as long-term data regarding this prosthesis are still lacking.
摘要：
背景：无菌性松动是全肘关节置换术（TEA）最常见的并发症之一。现代植入物，比如Nexel,旨在减少松动。本研究旨在报告植入物存活率，松动和通畅的射线照相评估，以及接受NexelTEA治疗的患者在中期随访时的患者报告结局指标（PROMs）。
方法：连续系列的成年患者由一名外科医生通过标准化技术使用Nexel进行TEA。包括至少3年随访的影像学和PROM数据的患者。生存是由缺乏修订定义的。由三名独立的研究金训练的肩和肘外科医生通过Wrightington方法评估松动。在正交射线照相上分析了各个射线照相区的透明度。PROM包括QuickDash（QDASH），患者额定弯头评估(PREE),和欧洲QoL（EQ5D）。
结果：连续38名患者（22名女性，16名男性），平均年龄为67岁，通过保留三头肌的孤立内侧窗方法接受了TEA。平均随访5.5年（范围3-9）。主要诊断为：19骨关节炎（OA），9类风湿性关节炎（RA），9创伤后关节炎（PA），1肘关节固定术的转换。总生存率为97.4%，一名患者因感染而接受翻修。5.3%的肘部出现松动,三个观察者的平均值。清醒在肱骨髁上最为明显。PROM显示出76％的显着和临床意义的改善，92%,73%的患者接受QDASH治疗，PREE,和EQ5D，分别。患者年龄之间没有发现显著的相关性，性别,松开,清醒，和PROMs。
结论：在中期随访时，NexelTEA显示出优异的总体生存率和较低的植入物松动率。需要翻修感染的单一失败是先前肘关节固定术的转换。从手术前到最终的手术后随访，PROM总体上表现出明显且一致的改善。虽然很有希望，这些结果应谨慎解释,因为仍缺乏有关该假体的长期数据.
方法：连续系列的成年患者由一名外科医生通过标准化技术使用Nexel进行TEA。包括至少3年随访的影像学和PROM数据的患者。生存是由缺乏修订定义的。由三名独立的研究金训练的肩和肘外科医生通过Wrightington方法评估松动。在正交射线照相上分析了各个射线照相区的透明度。PROM包括QuickDash（QDASH），患者额定弯头评估(PREE),和欧洲QoL（EQ5D）。
结果：连续38名患者（22名女性，16名男性），平均年龄为67岁，通过保留三头肌的孤立内侧窗方法接受了TEA。平均随访5.5年（范围3-9）。主要诊断为：19骨关节炎（OA），9类风湿性关节炎（RA），9创伤后关节炎（PA），1肘关节固定术的转换。总生存率为97.4%，一名患者因感染而接受翻修。5.3%的肘部出现松动,三个观察者的平均值。清醒在肱骨髁上最为明显。PROM显示出76％的显着和临床意义的改善，92%,73%的患者接受QDASH治疗，PREE,和EQ5D，分别。患者年龄之间没有发现显著的相关性，性别,松开,清醒，和PROMs。
结论：在中期随访时，NexelTEA显示出优异的总体生存率和较低的植入物松动率。需要翻修感染的单一失败是先前肘关节固定术的转换。从手术前到最终的手术后随访，PROM总体上表现出明显且一致的改善。虽然很有希望，这些结果应谨慎解释,因为仍缺乏有关该假体的长期数据.
