BACKGROUND: In the past decade the prevalence of end stage inflammatory elbow arthritis has declined with consequential changes in indications and utilization of total elbow arthroplasty (TEA). Current literature lacks future projections for the utilization of TEA. This aim of this study is to review the trends in utilization of TEA in last two decades and determine the projections of utilization for TEA (primary and revision) through 2060.
METHODS: This analysis utilized the publicly available 2000-2019 data from the CMS Medicare Part-B National Summary. Procedure volumes including TEA, and revision TEA, were determined using current procedural terminology (CPT) codes and were uplifted to account for the growing number of Medicare eligible patients covered under Medicare Advantage. Using these volumes log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average (ARIMA) models were applied to generate projections from 2020-2060. The Poisson model was chosen to display the data based on error analysis and prior literature.
RESULTS: The projected annual growth rate from 2020 to 2060 for primary and revision TEA are 1.03% growth (95% CI 0.82% - 1.25%) and 5.17% growth (95% CI 3.02%-6.97%), respectively. By 2060, the demand for primary TEA and revision TEA is projected to be 2084 procedures (95% FI 1995 - 2174) and 3161 procedure (95% FI 3052 - 3272), respectively. The procedure volume for revision TEA is estimated to outnumber primary TEA by year 2050.
CONCLUSIONS: The overall procedural volume of primary TEA, and revision TEA continues to be low. Although it is estimated that the incidence of primary and revision TEA will continue to increase in next 40 years, the utilization trends only show mild increase, which is five times higher for revision TEA compared to primary TEA.

OBJECTIVE: The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus.
METHODS: Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided.
METHODS: Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis.
METHODS: Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through a paratricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired.
METHODS: Early functional rehabilitation in a hinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed.
RESULTS: Between 2018 and 2022, 18 patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after a mean follow-up of 12 months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.
UNASSIGNED: OPERATIONSZIEL: Ziel der Operation ist der Ersatz der Gelenkfläche des distalen Humerus bei nicht rekonstruierbaren Frakturen des distalen Humerus.
UNASSIGNED: Aktive Patienten mit hohem funktionellem Anspruch, bei denen eine Gewichtslimitierung aufgrund einer Ellenbogentotalendoprothese vermieden werden soll.
UNASSIGNED: Kontraindikationen bestehen bei Frakturen mit nicht rekonstruierbaren Epikondylen und/oder nicht rekonstruierbaren Kollateralbändern sowie bei ulnohumeraler oder radiohumeraler Arthrose.
UNASSIGNED: Über einen paratrizipitalen Zugang erfolgt nach subkutaner, anteriorer Transposition des N. ulnaris die chirurgische Luxation des Gelenks durch humerales Ablösen der Weichteilstrukturen. Anschließend wird die Trochlea reseziert und der Humerus mittels Raspeln eröffnet, sodass anschließend die Hemiprothese unter retrograder Zementierung implantiert werden kann. Abschließend erfolgt die Rekonstruktion des medialen und lateralen Kollateralbandapparats sowie der Flexoren und Extensoren.
UNASSIGNED: Frühfunktionelle Beübung des Ellenbogens in der Bewegungsorthese unter Vermeidung von Varus‑/Valgusstress nach Abschluss der Wundheilung.
UNASSIGNED: Zwischen 2018 und 2022 wurden 18 Patienten mit koronaren Abscherfrakturen mit einer Hemiprothese versorgt. Der durchschnittliche Mayo Elbow Performance Score (MEPS) lag nach einem mittleren Nachverfolgungszeitraum von 12 Monaten bei 79 Punkten (70–95). Der durchschnittliche Bewegungsumfang betrug in Extension-Flexion 99° (70–130°), in Pronation-Supination 162° (90–180°).

UNASSIGNED: Classification systems are only useful if there is agreement among observers. The purpose of this study is to introduce a simple and clinically applicable classification system - The Copenhagen Classification System for Distal Humeral Fractures (CCDHF) and to compare the interobserver and intraobserver agreement for this classification with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA), and the Sheffield classification systems. The primary objective of the new classification system is to distinguish fractures that may not be suitable for open reduction and internal fixation, necessitating treatment options such as elbow hemiarthroplasty or total elbow arthroplasty (TEA).
UNASSIGNED: Five consultant elbow surgeons assessed a consecutive series of 105 sets X-rays of distal humeral fractures on 2 occasions with at least 10 weeks interval. All X-rays were classified according to AO/OTA, Sheffield, and the CCDHF systems. The CCDHF system has been developed collaboratively by a panel of five experienced elbow surgeons. Based on consensus, the surgeons identified specific fracture characteristics where elbow hemiarthroplasty or TEA might be needed.
UNASSIGNED: The mean interobserver agreement was fair for AO/OTA and moderate for Sheffield and the CCDHF. The mean intraobserver agreement was moderate for AO/OTA and substantial for Sheffield and the CCDHF. The observers were uncertain about the classification in 29% of the cases with the AO/OTA classification, 15% with the Sheffield classification, and 12% with CCDHF.
UNASSIGNED: The CCDHF demonstrated validity and clinical applicability and can assist surgeons in identifying fractures that may require hemiarthroplasty or TEA treatment.

Polymethyl methacrylate remains the only US Food and Drug Administration-approved method of total elbow arthroplasty fixation and exhibits high aseptic loosening rates that result in challenging revision surgeries and potential morbidity secondary to bone-cement implantation syndrome. In this policy paper, the authors aim to explore the historical background of polymethyl methacrylate and the complications that arise in association with its use. We will review arthroplasty trends in the elbow and lower extremities and the challenges with the US Food and Drug Administration-approval process.

UNASSIGNED: Total and hemi elbow arthroplasty (TEA/HEA) are relatively uncommon orthopedic procedures, but physiotherapists are involved in both pre- and postoperative treatment of people who undergo TEA/HEA. The purpose of this article is to summarize existing knowledge about the effects of rehabilitation versus standard care after total and hemi elbow arthroplasty (TEA/HEA).
UNASSIGNED: A systematic literature review was conducted searching Ovid MEDLINE ®, SweMED+, Cochrane, Embase, AMED and PEDro. \"The Preferred Reporting Items for Systematic Review and Meta-Analysis\" was followed.
UNASSIGNED: No one has studied the effects of rehabilitation after TEA/HEA. The aim of the only study included was to assess the safety and length of hospital stay (LOS) after omission of casting, start of early mobilization and implementation of functional discharge criteria. Results show that the non-casting cohort had a shorter mean LOS (5.4 days) than the index cohort (6.2 days). The cohort with functional discharge criteria had a shorter mean LOS (3.8 days) than the cohort without functional discharge (5.4 days).
UNASSIGNED: Effects of rehabilitation components or programs after TEA/HEA are still unknown. It is important to focus on the lack of evidence in this field, and plan for more studies to come.

暂无摘要。

Distal humerus fractures are a contemporary problem because the life expectancy, autonomy and functional demands of older patients continue to grow. This is combined with surgical advances in bone reconstruction, especially in fragile patients. A distal humerus fracture in an older adult is a serious injury with an uncertain prognosis. In fact, damage to the elbow joint in this complex anatomical area overwhelmed by low-quality bone occurs in patients who often have unfavorable characteristics (fragile skin, low physiological reserves, organ failure) combined with pharmaceutical treatments that can be iatrogenic. The treatment indication must not be based solely on the conventional radiographs used for classification purposes; the fracture and bone quality must be analyzed in three dimensions. Also, the surgeon must understand the patient\'s needs, worries and risks fully to decide between conservative treatment and anatomical locking plate fixation or elbow arthroplasty (hemi or total). In the end, the chosen treatment must allow at least 100̊ and preferably 120̊ of flexion-extension at the elbow. In this age range, the choice between arthroplasty and plate fixation is definitive; the surgical approach must make it possible to carry out either option, with arthroplasty implants available in case the trochlear fracture cannot be plated. The aim of this lecture is to provide a fresh perspective on the anatomy of the distal humerus, its fracture and the best surgical approaches, discuss how to decide on the indication, outline the safest and most reliable ways to reconstruct and stabilize the elbow, and lastly, summarize the expected outcomes and potential complications of each treatment option. Level of evidence: V; expert opinion.

UNASSIGNED: Intramedullary (IM) screw insertion into the distal humerus provides fixation for a novel, uncemented elbow arthroplasty. A multitude of screw sizes is required to accommodate variable humeral morphology. The goal of this study was to use computed tomography (CT) for IM screw sizing and to validate this templating by inserting screws into three-dimensionally (3D) printed models.
UNASSIGNED: Computed tomography humerus scans for 30 patients were reformatted in the plane of the distal IM canal. Screw size was templated by measuring the canal diameter at 3 locations corresponding to the lengths of the screws being tested. Interrater and intrarater reliabilities of the measurements were assessed. Three-dimensional models of 5 humeri were printed, and IM screws were placed to achieve a secure endosteal fit.
UNASSIGNED: We identified combinations of body components and IM screw length and diameter for all patients to seat this uncemented elbow arthroplasty. The measurements and screw width determinations were reliable. Canal diameter correlated with age but was unrelated to sex. Screws were inserted into five 3D-printed models which matched the templates and demonstrated mechanical and radiographic evidence of secure fit.
UNASSIGNED: This study characterizes distal humerus anatomy in the context of IM screw fixation. Humerus CT scans of 30 patients were able to be templated, and validation via implantation of IM screws into 3D models was successful. Computed tomography templating will allow surgeons to predict the optimal screw size prior to implantation. A broad range of screw lengths and diameters is critical for implantation of this novel elbow arthroplasty.

BACKGROUND: Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions on weight-bearing as opposed to TEA. These 2 treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients.
METHODS: This was a multicenter randomized controlled trial (RCT). Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥60 years and independent living. The final follow-up took place after ≥2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation, and supination) and grip strength.
RESULTS: Forty patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = .30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = .39), a difference of -5.6 points (95% CI: -18.6 to 7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = .59), EQ-5D index (0.92 vs. 0.86, P = .13), extension (29° vs. 29°, P = .98), flexion (126° vs. 136°, P = .05), arc of flexion-extension (97° vs. 107°, P = .25), supination (81° vs. 75°, P = .13), pronation (78° vs. 74°, P = .16) or grip strength (17.5 kg vs. 17.2 kg, P = .89). There were 6 adverse events in each treatment group.
CONCLUSIONS: In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.