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Understanding Overall Survival and Complication Rates following Total Elbow Arthroplasty: Does the Indication of Surgery Matter?
Azeem Tariq Malik, MBBS
1, Alexander Lee, MD
1, Amogh Iyer, BSE
1, Talal Ibrahim, MBBS
1, Jill Putnam, MD
2; Hisham M. Awan, MD
3(1)The Ohio State University Wexner Medical Center, Columbus, OH, (2)Ohio State University, Hand & Upper Extremity Center, Columbus, OH, (3)Hand & Upper Extremity Center, Ohio State University, Hand & Upper Extremity Center, Columbus, OH
Introduction Total Elbow Arthroplasty (TEA) remains a treatment option for distal humerus fractures, primary osteoarthritis (OA), rheumatoid arthritis (RA) and post-traumatic arthritis (PTA). There is limited evidence on how the diagnosis impacts complications and overall survival.
Methods The 2010-2022Q1 PearlDiver database was used to identify patients undergoing primary TEA for distal humerus fractures, OA, PTA and RA. Regression and survival analyses were conducted to assess for risk factors associated with TEA-specific complications.
Results Out of 5,380 patients included - 2,112 (39.3%) were done for distal humerus fractures, 1,196 (22.3%) for RA, 1,432 (26.6%) for OA and 640 (11.9%) for PTA. Age?75 years, having PTA (OR 2.72; p<0.001), OA (OR 2.30; p<0.001), RA (OR 2.06; p<0.001), and alcohol use disorder (OR 3.25; p=0.040) was associated with higher odds of 1-year Revision TEA. Doing a TEA for PTA (vs. distal humerus fracture) had higher odds of instability (OR 1.89; p=0.026), prosthetic joint infection (OR 2.78; p<0.001), and triceps insufficiency (OR 4.00; p=0.004). TEA for RA was associated with higher odds of all-cause 1-year revisions (OR 2.06; p<0.001), mechanical/implant related complications (OR 1.99; p=0.010), prosthetic joint infection (OR 2.55; p<0.001) and triceps insufficiency (OR 2.53; p=0.036). TEA for OA had higher odds of 1-year revisions (OR 2.30; p<0.001), mechanical/implant related complications (OR 1.98; p=0.013), periprosthetic fracture (OR 1.97; p=0.031), prosthetic joint infection (OR 1.74; p=0.002), and triceps insufficiency (OR 3.92; p<0.001).
The overall 5-year survival rate from a Revision TEA for each of the indications was as follows: distal humerus fracture (92.9%), RA (86.8%), OA (85.5%), and PTA (82.7%).
Cox-proportional hazard analysis showed that doing a TEA for PTA vs. distal humerus fracture had a higher risk of experiencing all-cause revisions (HR 1.65), instability (HR 1.92), and prosthetic joint infection (HR 1.53). TEA for RA also had higher hazard risk for experiencing mechanical/implant related complications (HR 1.38) and prosthetic joint infection (HR 1.58). TEA for OA had a higher risk for all-cause revision TEA (HR 1.33), mechanical/implant related complications (HR 1.64), and prosthetic joint infection (HR 1.27).
Conclusions
The findings of our study show that TEA 5-year survival rates range from 83%-93%. Patients who undergo a TEA for post-traumatic arthritis have the lowest revision-specific and PJI-specific 5-year survival, followed by osteoarthritis, and rheumatoid arthritis patients. We also found a higher odd of 1-year complications for TEAs done for post-traumatic arthritis, osteoarthritis and rheumatoid arthritis when compared to those done for distal humerus fractures.
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