Total elbow arthroplasty for unreconstructible distal humerus fracture sequelae in patients less than 40 year old. Long-term outcomes.

BACKGROUND

Total elbow arthroplasty (TEA) is rarely recommended in young patients because of a high risk of early failure. This study analyzes the long-term outcomes of a cohort of post-traumatic TEA patients under 40 years of age who received a linked semiconstrained implant to manage the sequelae of an unreconstructible distal humerus fracture.

MATERIAL AND

METHODS

A review of the patients who received a Coonrad-Morrey prosthesis between 1993 and 2013 to manage the sequelae of a distal humerus fracture identified 16 individuals with a minimum follow-up of 10 years who at the time of surgery were aged 40 years or less. A further patient required multiple implant revisions due to a deep elbow infection that ultimately prevented reimplantation and did not reach the minimum follow-up period. We excluded patients with inflammatory or rheumatoid arthritis. Clinical follow-up included the Mayo Elbow Performance Score, the Quick Disabilities of the Arm, Shoulder and Hand score, and triceps function. Overall satisfaction was also investigated. Radiographs were analyzed for component loosening, bushing wear, and periarticular ossifications.

RESULTS

The mean follow-up was 151 (range, 125-225) months. After TEA, mean flexion-extension was 99°; mean pronation-supination was 103°; the mean Mayo Elbow Performance Score was 82, and the mean Quick Disabilities of the Arm, Shoulder and Hand score was 12. At the last follow-up, 10 of 16 patients (62%) required revision surgery, 5 for component loosening, 4 for isolated bushing exchange, and 1 for bushing exchange with triceps reconstruction. Nonetheless, 14 (87%) were satisfied with the procedure.

CONCLUSION

Semiconstrained TEA should be considered as a salvage procedure in young post-traumatic patients with unreconstructible distal humerus fractures. In our experience, TEA can achieve satisfactory outcomes in terms of pain relief, stability, and range of movement. However, at a mean follow-up of 151 months, the long-term complication rate was high (62%). Further studies with larger cohorts are required to validate these findings.