Dataset Information

Management of elbow arthritis by interposition arthroplasty with abdominal dermal graft.

ABSTRACT:

Background

Interposition arthroplasty (IA) is one of the oldest reconstructive options for elbow arthritis and is an alternative to total elbow arthroplasty in young active patients with moderate to severe elbow arthritis. In literature there is very little, if any, mention about relationship of post-operative functional recovery and time. In this study we assess the clinical and functional outcome of interposition arthroplasty using abdominal dermal graft.

Methods

Study was conducted retrospective and prospectively during 2014-15 on 18 elbows of 17 patients (10 females and 7 male) which were operated between 2010 and 2015 for elbow arthritis by interposition arthroplasty using abdominal dermal graft by a single surgeon. Etiologically 10 cases were post-traumatic, 4 cases inflammatory joint disease and 4 cases were post-tubercular. All patients were operated using standard kochers approach and above elbow Plaster of Paris were applied in 90° flexion and mid prone position till suture removal i.e. 2 weeks and range of motion (ROM) exercises started. Post-operatively patients were reviewed on 1, 3, 6, 9, 12 months and then yearly. Functional assessments were done using Mayo Elbow Performance Score (MEPS).

Results

The mean age of the patients were 34.33 years (16 years-50 years) and follow-up duration of median 22 months (minimum 12 months and maximum 50 months). Pre-operative the ROM of the patients were 0°-75° with median value of 25° which were significantly improved to 55°-135° with median value of 120° which was statistically significant with p-value of less than 0.01. Preoperative MEPS were 15-70 with median value of 45 which was improved to 85 to 100 with median value of 95 with p-value less than 0.01. Post-operatively 14 elbows (77.8%) has excellent and 4 elbows (22.2%) has good result. 5 (27.7%) elbow has mild instability and in 3 patients has hypertrophic scar over donor site.

Conclusion

It's a very cost effective treatment as compared to total elbow arthroplasty. It provides superior functional outcome than other kind of salvageable procedure like arthrodesis and patient's satisfaction is very high after surgery as pain subsided and range of motion improved. Most of the patients returned to their previous occupation by 6 months after surgery.

SUBMITTER: Ahmed P

PROVIDER: S-EPMC7394806 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years' follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland's technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90 degrees and 120 degrees of flexion and 30 degrees and 90 degrees of extension. Post-operative range varied between 90 degrees and 150 degrees of flexion. The five cases of full pre-operative ankylosis achieved between 90 degrees and 150 degrees of flexion and between 0 degrees and 70 degrees of extension. The total range of motion at the latest follow-up varied from 35 degrees to 150 degrees . Patients who were able to perform flexion of 120 degrees or more were considered to be excellent, those between 90 degrees and 119 degrees were graded good, from 60 degrees to 89 degrees fair and those 59 degrees or less poor. The ability to attain a hand to mouth position requires a mobility of 120 degrees . We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed.