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Interposition elbow arthroplasty with Achilles tendon allograft may be effective salvage treatment for elbow arthritis, data indicate

Thursday, December 11 2008 | Comments
Evidence Grade 4 What's This?
Patients with inflammatory arthritis or posttraumatic arthritis of the elbow may benefit from interposition arthroplasty with an Achilles tendon allograft, new trial data demonstrate.

The investigators evaluated 69 patients with either inflammatory or posttraumatic arthritis who underwent interposition elbow arthroplasty with an Achilles tendon allograft between 1996 and 2003. Of these, 45 met the inclusion criteria for the study. The mean age at the time of presentation was 42 years. The main complaint was pain, stiffness, instability, or a combination of these complaints. The average follow-up duration was 6 years.

Seven patients required subsequent revision surgery and were excluded from the analysis. The study authors reviewed the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) Score, radiographs, and clinical outcomes of the remaining 38 patients.

The average flexion-extension arc improved from 51 degrees before the surgery to 97 degrees after the procedure (P<.001) for a mean improvement of 46 degrees. Prior to the surgery, the mean pronation was 44 degrees and the mean supination was 41 degrees. After the procedure, the mean pronation was 65 degrees and the mean supination was 58 degrees, which was a significant increase in pronation-supination (P=.003).

The average MEPS also improved from 41 points preoperatively to 65 points following the surgery (P<.0001). There was significant improvement in every component of the MEPS with the exception of the stability score. According to the MEPS, 13 (29%) of the initial 45 patients had a good or excellent result (MEPS of >=75 points), 14 patients (31%) had a fair result (MEPS of >=60 but <75 points), and 11 patients (24%) had a poor result (MEPS of <60 points).

Despite efforts to reconstruct the collateral ligaments, preoperative instability on physical examination (found in 11 patients) was associated with low MEPS (P=.03) and high DASH scores (P=.006). Four of the 5 patients who underwent reconstruction of both collateral ligaments had a net decrease in the MEPS.

"[I]n selected individuals who are too young or too active for total elbow replacement, interposition arthroplasty may be a reasonable interim treatment for severe elbow arthritis, giving improved motion with fair to good functional outcomes... ." the authors concluded. (Larson AN and Morrey B. J Bone Joint Surg Am 2008;90:2714-2723.)

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