Total Elbow Arthroplasty from Indian Perspective: A Systematic Review,Indian Journal of Orthopaedics

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Total Elbow Arthroplasty from Indian Perspective: A Systematic Review
Indian Journal of Orthopaedics ( IF 1.1 ) Pub Date : 2022-09-24 , DOI: 10.1007/s43465-022-00744-y
Vivek Tiwari ₁ , Samir Dwidmuthe ₁

Affiliation

Background

Total elbow arthroplasty (TEA) provides satisfactory pain relief and restores elbow range of motion and function in patients with end-stage arthritis. Due to advances in implant design and surgical techniques, the indications for surgery have expanded to include various other conditions affecting the elbow. The previous studies and systematic reviews reported satisfactory mid-term and long-term clinical outcomes after TEA with relatively stable complication and revision rates. However, there is lack of information in the literature about the results of TEA in Indian patients.

Methods

Two reviewers performed a comprehensive literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in three online databases—Pubmed/MEDLINE, Google scholar and the Cochrane database for clinical trials. Only original studies published in the English literature reporting outcomes of primary TEA in Indian patients were included for analysis. Using pre-defined inclusion and exclusion criteria, articles were screened and the relevant articles identified. Data were extracted with the primary objective to assess pain relief and functional outcome after TEA in Indian patients, and secondary objective to identify indications for surgery, complication rates and incidence of implant removals.

Results

A total of 212 TEAs (210 patients) from ten articles were included in this systematic review. All the TEAs were done using Baksi’s semi-constrained sloppy-hinged elbow prosthesis. The most common indication of TEA was post-traumatic sequelae (124 elbows, 58.5%), followed by comminuted intra-articular fracture distal humerus (53 elbows, 25%). At a weighted mean follow-up of 7.5 years, 80.7% cases had complete pain relief. The weighted mean flexion, extension restriction, supination and pronation were 122.6°, 20.8°, 57.3°, and 48.6°; respectively. The weighted mean Mayo Elbow Performance Score was 92.1 points with excellent outcome. Overall, a total of 68 complications were reported (32%) and the implants needed to be removed in 14 elbows (6.6%) including two revisions.

Conclusions

This systematic review found that the functional outcome and pain relief obtained with TEA using Baksi’s sloppy-hinged prosthesis in Indian patients were satisfactory overall. The complication rates and implant removal rates were lower than those reported with other patient populations.

中文翻译：

印度视角下的全肘关节置换术：系统评价

背景

全肘关节置换术（TEA）可以有效缓解终末期关节炎患者的疼痛并恢复肘部的活动范围和功能。由于植入物设计和手术技术的进步，手术适应症已经扩大到包括影响肘部的各种其他病症。既往研究和系统评价报告了TEA术后中长期临床结果令人满意，并发症和翻修率相对稳定。然而，文献中缺乏有关印度患者 TEA 结果的信息。

方法

两名审稿人使用系统评价和荟萃分析首选报告项目 (PRISMA) 指南在三个在线数据库（Pubmed/MEDLINE、谷歌学者和临床试验 Cochrane 数据库）中进行了全面的文献检索。仅纳入报告印度患者原发性 TEA 结果的英文文献中发表的原始研究进行分析。使用预先定义的纳入和排除标准，筛选文章并识别相关文章。提取数据的主要目的是评估印度患者 TEA 后的疼痛缓解和功能结果，次要目的是确定手术适应症、并发症发生率和植入物移除的发生率。

结果

本系统评价共纳入 10 篇文章的 212 名 TEA（210 名患者）。所有 TEA 都是使用 Baksi 的半约束松散铰接肘假体完成的。TEA 最常见的适应症是创伤后后遗症（124 肘，58.5%），其次是肱骨远端关节内粉碎性骨折（53 肘，25%）。在 7.5 年的加权平均随访中，80.7% 的病例疼痛完全缓解。加权平均屈曲、伸展限制、旋后和旋前分别为122.6°、20.8°、57.3°和48.6°；分别。Mayo 肘部表现加权平均得分为 92.1 分，成绩优异。总体而言，总共报告了 68 例并发症 (32%)，其中 14 个肘部 (6.6%) 需要移除植入物，其中包括两次修复。