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- Jonsson, Eythor, 1982, et al.
(författare)
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Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial
- 2024
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Ingår i: Journal of Shoulder and Elbow Surgery. - : Elsevier. - 1058-2746 .- 1532-6500. ; 33:2, s. 343-355
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Tidskriftsartikel (refereegranskat)abstract
- 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. Material and 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. Conclusion: 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.
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| 2. |
- Jonsson, Eythor, 1982, et al.
(författare)
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Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients over 70 years of age: a multicenter randomized controlled trial.
- 2021
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Ingår i: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1532-6500 .- 1058-2746. ; 30:5, s. 994-1006
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Tidskriftsartikel (refereegranskat)abstract
- The most appropriate treatment for displaced multifragment proximal humeral fractures in elderly patients is currently unclear. Reverse total shoulder arthroplasty (rTSA) is a promising treatment option that is being used increasingly. The purpose of this study was to compare the outcome of rTSA with hemiarthroplasty (HA) for the treatment of displaced 3- and 4-part fractures in elderly patients.This is a multicenter, randomized controlled trial. We included patients over 70 years of age with displaced 3- or 4-part proximal humeral fractures between September 2013 and May 2016. The minimum follow-up was 2 years with outcome measures including the Constant score (primary outcome), the Western Ontario Osteoarthritis of the Shoulder (WOOS) index, the EQ-5D, range of motion, as well as pain and shoulder satisfaction assessed on a visual analog scale (VAS).We randomized 99 patients to rTSA (48 patients) and HA (51 patients). Fifteen patients were lost to follow-up, leaving 41 rTSA and 43 HA patients for analysis. Their mean age was 79.5 years and there were 76 females (90%). The rTSA group had a mean Constant score of 58.7, compared with 47.7 in the HA group, a mean difference of 11.1 points (95% CI, 3.0-18.9, P =0.007). Compared with HA, rTSA patients had greater mean satisfaction with their shoulder (79 vs 63mm, P = 0.011); flexion (125° vs 90°; P < 0.001) and abduction (112° vs 83°, P < 0.001), but there was no difference for WOOS, pain or the EQ-5D. We identified three and four adverse events in the rTSA and HA groups, respectively. For patients 80 years or older (n = 38), there was no difference between treatment with rTSA and HA for pain (17 vs 9mm, P = 0.17) or shoulder satisfaction (77 vs 74mm, P = 0.73).We found that rTSA provides better shoulder function than HA as measured with the Constant score, further emphasized by rTSA patients being more satisfied with their shoulder function. The difference appears to be mainly due to a better range of motion (abduction and flexion) in the rTSA group. The results also indicate that patients over 80 years of age benefit less from an rTSA than patients between 70 and 79 years of age.Level I; Randomized Controlled Trial; Treatment Study.
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| 3. |
- Jonsson, Eythor, 1982, et al.
(författare)
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The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period
- 2023
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Ingår i: JSES International. - : Elsevier BV. - 2666-6383. ; 7:3, s. 499-505
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Oxford Elbow Score (OES) is a well-validated, elbow-specific, patient-reported outcome measure (PROM), originally assigned a 4-week recall period. For PROMs, short recall periods could have some advantages, such as optimizing validity by minimizing the negative effects of inaccurate recollection and temporal trends (increase or decrease) in symptoms over the course of the recall period. Temporal trends in elbow function can, for example, be expected to occur over 4 weeks in patients recovering from an injury or surgery. The purpose of this study was to evaluate the measurement properties of the OES using a shortened, 7-day, recall period (OES-7d). Methods: The inclusion criteria were fracture, tendon rupture or dislocation affecting the elbow, and age ≥18 years. Patients with Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores of ≥10 points preinjury (pre-existing upper extremity condition) or concurrent upper extremity injuries were excluded. Patients completed the OES-7d, QuickDASH, and Single Assessment Numeric Evaluation-Function for the last 7 days preinjury (T1), the first 7 days postinjury (T2) and a 7-day period 3-5 months postinjury (T3). Correlations were assessed with Spearman's rho. Analyses of construct validity (correlation between scores) and internal consistency (Cronbach's alpha) were based on T3 data. Responsiveness was assessed by correlating changes in scores (change scores) between time points. Intra-rater reliability was assessed by calculating intraclass correlation coefficients based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1-2 years previously. Results: Seventy-five patients (45 women) were included between May 2020 and July 2021. Their mean age was 51.7 years. At T3, Spearman's rho was −0.91 for the correlation between OES total and QuickDASH scores and 0.76 for the correlation between OES total scores and Single Assessment Numeric Evaluation-Function values (construct validity). Spearman's rho for correlation between OES total and QuickDASH change scores from T2 to T3 (T3 minus T2) was −0.85 (responsiveness for improvement) and −0.88 for change scores from T1 to T2 (T2 minus T1, responsiveness for deterioration). For the OES domains, Cronbach's alpha was 0.83 for elbow function, 0.91 for pain and 0.90 for social-psychological domains. The intraclass correlation coefficient for the OES total score was 0.96. Conclusion: The OES demonstrated good measurement properties when used with a 7-day recall period (OES-7d). These results further establish the OES as a well-validated, elbow-specific PROM and support using a 7-day recall period.
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| 4. |
- Jonsson, Eythor Örn, 1982
(författare)
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Proximal and distal humeral fractures. Outcome of primary arthroplasty
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with both proximal humeral fractures and elbow injuries, especially distal humeral fractures. The main focus is difficult fractures in the elderly. Few randomized controlled trials (RCTs) are available. If the joint surface is considerably affected (e.g. comminution and displacement), arthroplasty is a treatment option. Comparing more recently introduced types of arthroplasty with established types lies at the center of this thesis. In Study I, reverse total shoulder arthroplasty (rTSA) was compared with hemiarthroplasty (HA), the established type of arthroplasty for proximal humeral fractures for many years. The understanding that tuberosity healing has a positive effect on the outcome of HA following the treatment of proximal humeral fractures is widespread. The available evidence has not, however, been summarized in a meta-analysis, which was done in Study II. In Study III, elbow hemiarthroplasty (EHA) was compared with total elbow arthroplasty (TEA), an established treatment for distal humeral fractures. Patient-reported outcome measures (PROMs), such as the Oxford Elbow Score (OES), are used increasingly. A short recall period may have advantages for PROMs. The effect of shortening the recall period for the OES was explored in Study IV. Study I: In an RCT, of patients with 3- or 4-part proximal humeral fractures (≥ 70 years of age), the mean Constant score was higher for rTSA (n = 41) than for HA (n = 43, 58.7 vs. 47.7, 95% CI: 3.0–18.9) as was mean flexion (125° vs. 90°, 95% CI: 20–49°) and abduction (112° vs. 83°, 95% CI: 15–43°). Study II: In a systematic review and meta-analysis, tuberosity healing (n = 317) was found to provide better function than failed tuberosity healing (n = 217) for patients treated with HA for proximal humeral fractures with better Constant scores (mean difference (MD) = 10.8 points, 55.4 vs. 44.6, 95% CI: 3.8–17.9) and flexion (MD = 34°, 107° vs. 73°, 95% CI: 23– 46°). Study III: In an RCT, patients (≥ 60 years of age) with unreconstructable distal humeral fractures had similar function following treatment with EHA (n = 18) and TEA (n = 17) in terms of mean Disabilities of the arm, shoulder and hand (DASH) scores (21.6 vs. 27.2, 95% CI: −7.5–18.6) and Mayo elbow performance scores (MEPS, 85.0 vs. 88.2, 95% CI: −8.9–15.4). Study IV: When used with a 7-day recall period, the OES (75 patients) demonstrated good measurement properties (construct validity, responsiveness and reliability). In conclusion, rTSA provides better shoulder function than HA for elderly patients with displaced 3- and 4-part proximal humeral fractures, at least in most elderly women. Moreover, tuberosity healing provides better shoulder function than failed tuberosity healing after treatment with HA for a proximal humeral fracture. For unreconstructable distal humeral fractures, EHA and TEA provide similar function, at least in elderly women. Other factors, such as activity level, should be considered when choosing between these treatments. The results of Study IV further establish the OES as a well-validated, elbow-specific PROM and support the use of a 7-day recall period.
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| 5. |
- Paulsson, Martin, et al.
(författare)
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Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial
- 2021
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Ingår i: Geriatric Orthopaedic Surgery & Rehabilitation. - : SAGE Publications. - 2151-4585 .- 2151-4593. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods: Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, BI, B2, CI, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results: Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions: There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.
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