Abstract
Purpose:
Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome.
Method.
We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded.
Summary of results:
In 12 (75%) cases at least one revision operation was performed, because of sepsis, ulnar nerve symptoms, instability and unsatisfactory clinical results. Sepsis rate was 25%. In 7 cases there was an unsatisfactory clinical result (i.e. ongoing pain and poor function), resulting in revision by total elbow replacement in 4 cases, arthrodesis in 2 cases and a re-do interposition in 1 case. The mean interval from the interposition to revision procedure was 2.6 (0.6–7.4) years. In 9 patients with the interposition currently in situ, mean VAS improved from 7.4 to 2.4 and mean MEPS from 42 (30–60) to 75 (40–100).
Conclusion:
Interposition arthroplasty offered improvement in pain and function, but at a high cost. It is associated with a high rate of complications and need for revision surgery that we feel might be unacceptable.
