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- Jonsson, Eythor, 1982, et al.
(author)
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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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In: Journal of Shoulder and Elbow Surgery. - : Elsevier. - 1058-2746 .- 1532-6500. ; 33:2, s. 343-355
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Journal article (peer-reviewed)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. |
- Nordqvist, Anders, et al.
(author)
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Axelns sjukdomar
- 2007
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In: Läkartidningen. - 0023-7205. ; 104:19, s. 6-1492
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Journal article (peer-reviewed)abstract
- The authors were requested to analyse the frequency of shoulder surgery at the different orthopaedic units of Sweden and to propose national indications according to evidence in literature.(nko.se) Three main groups of shoulder disorders were studied: subacromial pain, shoulder instability and pain caused by degenerative glenohumeral pathology. About 6500 shoulders were operatively treated in Sweden 2004. Since 1998 there has been an annual increase of about 10 per cent. Variations in incidences were seen between different parts of the country. The indications and techniques of shoulder surgery have improved during the last years - further knowledge of the disorders, new arthroscopic techniques, modern prosthetic design etc. The morbidity has decreased and ambulatory surgery has been more frequent. The indications and techniques of modern shoulder surgery generally are evidence based according to literature but in some field further prospective, randomized studies are indicated.
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