Outcomes and Complications of Elbow Arthrodesis.

Abstract

Background: Arthrodesis of the elbow is a rarely performed procedure sometimes considered when no other reliable surgical solutions exist. Most published reports are limited to single case reports or very small series. The purpose of this study was to evaluate the outcomes and complications of patients who underwent elbow arthrodesis and to determine whether this is a worthwhile salvage procedure for elbows not amendable to surgical reconstruction or arthroplasty.

Methods: Between 2000 and 2024, a retrospective review was performed of 13 elbows (13 patients) that underwent elbow arthrodesis at a single tertiary academic institution. There were 11 males and 2 females with a mean age of 42 years at the time of arthrodesis. Most arthrodeses (92%) were performed for posttraumatic arthritis. Electronic medical records were reviewed to collect demographic and clinical data, details of the surgical procedure, clinical outcomes and complications. Additionally, patients were contacted at the time of this study to collect Visual Analogue Scale (VAS) for pain, Single Numeric Assessment Evaluation (SANE), Mayo Elbow Performance Score (MEPS), subjective satisfaction, and any additional reoperations or complications. Postoperative radiographs were evaluated to determine union and identify possible radiographic complications. The arthrodesis angle was also measured on lateral postoperative radiographs.

Results: The mean follow-up of this study was 7 years. The mean postoperative arthrodesis angle was in 75 degrees of flexion. Patient outcomes could be obtained at most recent follow up for 9 of 13 patients. At most recent follow-up, average VAS scores for pain were 2 at rest and 4 with activity. The mean MEPS and SANE were 49 and 46. The overall satisfaction score was 8/10 and 57% of patients reported to be better or much better than before surgery. Complications, including nonunion or periprosthetic fracture, occurred in 6 (46%) elbows, 5 (39%) of which led to revision surgery.

Conclusion: Elbow arthrodesis demonstrated reasonable pain relief and subjective satisfaction for patients with severe destruction of the elbow joint despite poor functional outcomes. The combined rate of nonunion or postoperative fracture was greater than 40%. Elbow arthrodesis is a salvage procedure that should be only considered when no other reconstructive or arthroplasty options exist.

Level of evidence: Level IV, Case Series, Treatment Study.