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Meta-Analysis
. 2019 Dec;101-B(12):1489-1497.
doi: 10.1302/0301-620X.101B12.BJJ-2019-0799.R1.

Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis

Jou-Hua Wang  1 , Hsuan-Hsiao Ma  2   3 , Te-Feng A Chou  2   3 , Shang-Wen Tsai  2   3 , Cheng-Fong Chen  2   3 , Po-Kuei Wu  2   3 , Wei-Ming Chen  2   3
Affiliations
Meta-Analysis

Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis

Jou-Hua Wang et al. Bone Joint J. 2019 Dec.

Abstract

Aims: The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications.

Materials and methods: We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy).

Results: This study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy.

Conclusion: The aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery. Cite this article: Bone Joint J 2019;101-B:1489-1497.

Keywords: Aetiology; Osteoarthritis; Outcome; Rheumatoid arthritis; Total elbow arthroplasty; Trauma.

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Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart for the searching and identification of included studies.
Fig. 2
Fig. 2
Analysis of the likelihood of aseptic loosening in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 3
Fig. 3
Analysis of the likelihood of septic loosening in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 4
Fig. 4
Analysis of the likelihood of bushing wear, axle failure, component disassembly, and component fracture in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 5
Fig. 5
The effect of aetiologies (rheumatoid arthritis (RA) versus post-traumatic conditions) on arc of range of movement. Std diff, standardized difference; CI, confidence interval.
Fig. 6
Fig. 6
The effect of aetiologies (rheumatoid arthritis (RA) versus post-traumatic conditions) on Mayo Elbow Performance Score. Std diff, standardized difference; CI, confidence interval.
Fig. 7
Fig. 7
The effect of aetiologies (rheumatoid arthritis (RA) versus post-traumatic conditions) on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Std diff, standardized difference; CI, confidence interval.
Fig. 8
Fig. 8
Analysis of the likelihood of deep infection in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 9
Fig. 9
Analysis of the likelihood of intraoperative fracture in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 10
Fig. 10
Analysis of the likelihood of postoperative fracture in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
Fig. 11
Fig. 11
Analysis of the likelihood of ulnar neuropathy in the rheumatoid arthritis (RA) group versus the post-traumatic group. CI, confidence interval.
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