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Related Concept Videos

Bones of the Upper Limb: Humerus01:19

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Elbow Arthroplasty: A Concise Literature Update.

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Total elbow arthroplasty (TEA) is a viable option for elderly patients with rheumatoid arthritis or distal humerus fractures. Recent literature indicates favorable survival rates and functional outcomes compared to other surgical methods.

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Area of Science:

  • Orthopedic Surgery
  • Rheumatology
  • Biomedical Engineering

Background:

  • Total elbow arthroplasty (TEA) is increasingly utilized for managing complex elbow conditions.
  • Indications include rheumatoid arthritis (RA) and distal humerus fractures (DHFs), particularly in elderly populations.

Purpose of the Study:

  • To review and synthesize recent (2022) literature on the efficacy and outcomes of TEA.
  • To compare TEA with alternative treatments like open reduction and internal fixation (ORIF) and distal humeral hemiarthroplasty (DHH).
  • To evaluate the success rates of different surgical strategies for periprosthetic joint infection (PJI) following TEA.

Main Methods:

  • Narrative review of recent literature published in 2022.
  • Analysis of comparative studies and outcome data for TEA versus ORIF and DHH.
  • Review of periprosthetic joint infection (PJI) eradication rates for various surgical interventions.

Main Results:

  • Age over 80 is not a contraindication for TEA.
  • Estimated 10-year survival rates: 92% for linked TEA, 84% for unlinked TEA.
  • TEA demonstrates superior flexion/extension arc, lower reoperation, and reduced elbow stiffness rates compared to ORIF for elderly DHFs.
  • DHH shows better range of motion than TEA for non-reconstructable DHFs in those over 65, with similar adverse event rates.
  • PJI eradication rates: 69-76% (two-stage), 71% (resection arthroplasty), 67% (one-stage), 58% (DAIR), 40% (elbow arthrodesis).

Conclusions:

  • TEA is a safe and effective procedure with good long-term survival, even in octogenarians.
  • TEA offers significant functional advantages over ORIF for elderly patients with DHFs.
  • While DHH may offer better ROM for specific DHF cases, adverse event rates are comparable to TEA.
  • Two-stage revision and resection arthroplasty show the highest success rates for PJI eradication.