Purpose

Interposition arthroplasty for the post-traumatic osteoarthritic elbow is a salvage procedure used in young and active patients and remains a rare and unexplored therapeutic option.

Methods

We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and EMBASE. The primary objective was to synthesize functional outcomes and to investigate revision frequencies, but also complication and subsequent surgery rates among patients with surviving grafts. The preferred reporting guidelines for systematic reviews and meta-analyses guidelines were applied.

Results

Five studies were left for inclusion, all retrospective in design, comprising 67 patients. The mean age was 40 years, the mean follow-up period was 61 months, and 68.2% of the patients treated were male. Eleven patients (16.4%) were treated with fascia lata autografts, and 56 patients (83.6%) were treated with Achilles tendon allografts. The graft survived in 53 patients (79.1%); the post-operative Mayo Elbow Performance Score averaged 69 points. Fourteen patients (20.9%) required revision surgery. In the setting of graft survival, 39.1% of patients had complications not requiring further surgical treatment and 5.7% of patients with surviving grafts needed subsequent operative treatment within the follow-up period.

Conclusion

Given graft survival, this systematic review demonstrated satisfactory functional outcomes following interposition arthroplasty of the post-traumatic osteoarthritic elbow, however, associated with a cumulative complication and subsequent operative treatment rate of 44.8%. In addition, a revision rate of 20.9% needs to be expected. Varus-valgus instability in the pre-operative clinical assessment seems to be associated with unsatisfactory post-operative elbow function. The superiority of either of the two main reported graft methods (fascia lata autograft and Achilles tendon allograft) remains pending, and the role of an external fixator in preventing post-operative instability remains unresolved.

中文翻译：

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肘部创伤后骨关节炎的介入关节成形术：系统评价

目的

创伤后骨关节炎肘关节置换术是一种用于年轻和活跃患者的抢救手术，并且仍然是一种罕见且未经探索的治疗选择。

方法

我们系统地回顾了使用 PubMed 界面和 EMBASE 检索电子数据库、MEDLINE 的可用文献。主要目标是综合功能结果并调查翻修频率，以及存活移植物患者的并发症和随后的手术率。应用了系统评价和荟萃分析指南的首选报告指南。

结果

五项研究被纳入，所有研究均采用回顾性设计，包括 67 名患者。平均年龄为 40 岁，平均随访时间为 61 个月，接受治疗的患者中有 68.2% 为男性。11 名患者（16.4%）接受了自体阔筋膜移植，56 名患者（83.6%）接受了同种异体跟腱移植。移植物在 53 名患者（79.1%）中存活；术后梅奥肘关节表现评分平均为 69 分。14 名患者 (20.9%) 需要进行翻修手术。在移植物存活的情况下，39.1% 的患者出现不需要进一步手术治疗的并发症，5.7% 的移植物存活患者在随访期内需要后续手术治疗。

结论

考虑到移植物存活率，该系统评价显示创伤后骨关节炎肘关节置换术后令人满意的功能结果，然而，与累积并发症和随后的手术治疗率为 44.8% 相关。此外，需要预计 20.9% 的修订率。术前临床评估中的内翻-外翻不稳定性似乎与术后肘部功能不理想有关。两种主要报道的移植方法（自体阔筋膜和同种异体跟腱）中的任何一种的优越性仍然悬而未决，外固定器在预防术后不稳定中的作用仍未得到解决。