Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial.

Oct 02, 2023

Experts: Eythor Ö Jonsson,Carl Ekholm,Hanna Björnsson Hallgren,Jens Nestorson,Mikael Etzner,Lars Adolfsson

Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions in weight-bearing as opposed to TEA. These two treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients.
This was a multicenter RCT. Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥ 60 years and independent living. The final follow-up took place after ≥ 2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation and supination) and grip strength.
40 patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = 0.30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = 0.39), a difference of -5.6 points (95% CI: -18.6-7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = 0.59), EQ-5D index (0.92 vs. 0.86, P = 0.13), extension (29° vs. 29°, P = 0.98), flexion (126° vs. 136°, P = 0.05), arc of flexion-extension (97° vs. 107°, P = 0.25), supination (81° vs. 75°, P = 0.13), pronation (78° vs. 74°, P = 0.16) or grip strength (17.5 kg vs. 17.2 kg, P = 0.89). There were 6 adverse events in each treatment group.
In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Eythor Ö Jonsson,Carl Ekholm,Hanna Björnsson Hallgren,Jens Nestorson,Mikael Etzner,Lars Adolfsson

Eythor Ö Jonsson

Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden. Electronic address: eythororn@gmail.com.

Carl Ekholm

Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.

Hanna Björnsson Hallgren

Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linko¨ping University, Linko¨ping, Sweden.

Jens Nestorson

Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linko¨ping University, Linko¨ping, Sweden.

Mikael Etzner

Hallands Hospital Varberg, Varberg, Sweden.

Lars Adolfsson

Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linko¨ping University, Linko¨ping, Sweden; Department of Orthopaedics, Örebro University, Örebro, Sweden.