Total elbow arthroplasty: Influence of implant positioning on functional outcomes

Autor: I. Djerbi, Bertrand Coulet, Hubert Lenoir, Cyril Lazerges, Jean-Paul Micallef, Michel Chammas, Thomas Waitzenegger
Přispěvatelé: Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Euromov (EuroMov), Université de Montpellier (UM), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Rok vydání: 2015
Předmět:
Adult
Male
musculoskeletal diseases
medicine.medical_specialty
Elbow
Elbow Prosthesis
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Patient Positioning
03 medical and health sciences
0302 clinical medicine
Elbow Joint
Dash
Humans
Medicine
Orthopedics and Sports Medicine
Humerus
030212 general & internal medicine
Range of Motion
Articular
Aged
Retrospective Studies
Aged
80 and over
030222 orthopedics
biology
business.industry
Arthroplasty
Replacement
Elbow
Ulna
Soft tissue
Retrospective cohort study
Middle Aged
musculoskeletal system
biology.organism_classification
Surgery
Total elbow arthroplasty
body regions
Valgus
medicine.anatomical_structure
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Rotation axis
Female
Implant
Anatomy
Joint Diseases
business
Positioning
Zdroj: Orthopaedics and Traumatology-Surgery and Research
Orthopaedics and Traumatology-Surgery and Research, Elsevier, 2015, 101 (6), pp.721-727. ⟨10.1016/j.otsr.2015.07.008⟩
ISSN: 1877-0568
Popis: Background Restoring the axis of rotation is often considered crucial to achieving good functional outcomes of total elbow arthroplasty. The objective of this work was to evaluate whether variations in implant positioning correlated with clinical outcomes. Hypothesis Clinical outcomes are dictated by the quality of implant positioning. Material and methods A retrospective review was conducted of data from 25 patients (26 elbows). Function was assessed using a pain score, the Disabilities of the Arm, Shoulder, and Hand (DASH) Score, and the Mayo Elbow Performance Score (MEPS). The patients also underwent a clinical evaluation for measurements of motion range and flexion/extension strength. Position of the humeral and ulnar implants was assessed by computed tomography with reconstruction using OsiriX software. Indices reflecting anterior offset, lateral offset, valgus, height, and rotation were computed by subtracting the ulnar value of each of these variables from the corresponding humeral value. These indices provided a quantitative assessment of whether position errors for the two components had additive effects or, on the contrary, counterbalanced each other. Elbows with prosthetic loosening or extensive epiphyseal destruction were excluded. Results Of the 26 elbows, 5 were excluded. In the remaining 21 elbows, the discrepancy between the humeral and ulnar lateral offsets was significantly associated with pain intensity ( P ≤ 0.05) and the MEPS ( P ≤ 0.05). Anterior position of the ulna relative to the humerus was associated with decreased extension strength ( P ≤ 0.05) and worse results for all functional parameters ( P ≤ 0.05). Discussion In the absence of loosening, positioning errors seem to adversely affect functional outcomes, probably by placing inappropriate stress on the soft tissues. Level of evidence III.
Databáze: OpenAIRE
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