Total elbow arthroplasty versus hemiarthroplasty for acute distal humeral fractures: A retrospective cohort study of revision rates in 366 consecutive patients.

Abstract

Background: Elbow arthroplasty is an established treatment of distal humeral fractures not amenable to internal fixation. Total elbow arthroplasty (TEA) is the most common modality, but elbow hemiarthroplasty (EHA) is becoming more popular, and it is still unclear which option provides the best results. We hypothesized that EHA is associated with a lower revision rate than TEA, due to fewer mechanical complications.

Methods: This study is a retrospective multi-center cohort study. We identified all patients with an acute distal humeral fracture treated with an elbow arthroplasty in Denmark in the period from January 1, 2008 until December 1, 2021. Data was collected retrospectively using electronic health records. Kaplan-Meier analysis was used to estimate the cumulative revision rates for TEA and EHA. Hazard ratios (HR) were estimated using the Cox proportional hazards model with mutual adjustment for age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and implant type (TEA or EHA).

Results: 225 TEA and 141 EHA procedures were included. There were 21 revisions of TEAs and 11 of EHAs. The 2-, 5- and 10-year revision rates were 5.8% (95% confidence interval [CI] 2.5% - 9.2%), 8.6% (95% CI 4.4% - 12.8%) and 20.5% (95% CI 9.2% - 31.9%) for TEA, and 4.0% (95% CI 0.5% - 7.5%), 9.3% (95% CI 3.0% - 15.6%), and 18.7% (95% CI 4.8% - 32.7%) for EHA. After adjustment, the HR of revision for male patients was 3.8 (95% CI 1.6 - 9.1). The HR of revision for EHA was 0.9 (95% CI 0.4 - 1.9) with TEA as reference.

Conclusion: We found comparable, but high revision rates of TEA and EHA after unreconstructable distal humeral fracture. An important finding was a four times higher risk of revision for male patients. Larger studies are needed for more reliable estimates.