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Meta-Analysis
. 2020 Aug;102-B(8):967-980.
doi: 10.1302/0301-620X.102B8.BJJ-2019-1465.R1.

Total elbow arthroplasty in patients with rheumatoid arthritis

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

Total elbow arthroplasty in patients with rheumatoid arthritis

Te-Feng A Chou et al. Bone Joint J. 2020 Aug.

Abstract

Aims: The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome.

Methods: We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome.

Results: A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening.

Conclusion: TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967-980.

Keywords: Complication; Function; Implant failure; Outcome; Rheumatoid arthritis; Survival; Total elbow arthroplasty; Total elbow replacement.

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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
Forest plot of pooled implant failure rates among included studies. CI, confidence interval.
Fig. 3
Fig. 3
Forest plot of pooled aseptic loosening rates among included studies. CI, confidence interval.
Fig. 4
Fig. 4
Forest plot of pooled septic loosening rates in the studies. CI, confidence interval.
Fig. 5
Fig. 5
Forest plot of pooled instability rates in the studies. CI, confidence interval.
Fig. 6
Fig. 6
Forest plot of pooled bushing wear, axle failure, or implant fracture rates in the studies. CI, confidence interval.
Fig. 7
Fig. 7
Forest plot of pooled total complication rates in the studies. CI, confidence interval.
Fig. 8
Fig. 8
Forest plot of pooled degrees of flexion in the studies. CI, confidence interval.
Fig. 9
Fig. 9
Forest plot of pooled degrees of extension in the studies. CI, confidence interval.
Fig. 10
Fig. 10
Forest plot of pooled degrees of pronation in the studies. CI, confidence interval.
Fig. 11
Fig. 11
Forest plot of pooled degrees of supination in the studies. CI, confidence interval.
Fig. 12
Fig. 12
Forest plot of pooled arc of range of motion in the studies. CI, confidence interval.
Fig. 13
Fig. 13
Forest plot of pooled Mayo Elbow Performance Score (MEPS) in the studies. CI, confidence interval.
See this image and copyright information in PMC

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