Our Summary

This research paper looked into a rare treatment option for a type of elbow arthritis that happens after an injury, especially in young and active patients. This treatment, called interposition arthroplasty, involves placing a graft (a piece of tissue) in the joint to improve its function.

The researchers analyzed studies on this procedure, focusing on how well the grafts survived, how often they had to be replaced, and the rate of complications and additional surgeries. They found five relevant studies, which included 67 patients. Most of these patients were male and around 40 years old, and they were followed up for an average of 61 months.

The grafts survived in about 79% of patients, and overall, they had satisfactory results in terms of elbow function. However, about 21% of patients needed their grafts replaced. Also, about 44% of patients experienced complications or needed additional surgeries, even when their grafts survived.

The researchers also noted that patients who had instability in their elbows before the surgery were likely to have unsatisfactory results afterward. Finally, the study did not determine whether one type of graft (fascia lata autograft and Achilles tendon allograft) was better than the other, and it was unclear what role an external fixator might play in preventing instability after the surgery.

FAQs

  1. What is interposition arthroplasty and how does it treat elbow arthritis?
  2. What were the main findings of the research on interposition arthroplasty for elbow arthritis?
  3. Did the study find a preferable type of graft for the interposition arthroplasty procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about elbow surgery is to follow post-operative care instructions carefully, including attending physical therapy sessions as recommended. This can help improve the success of the surgery and decrease the risk of complications. Additionally, it is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Overall, patients who are typically recommended for elbow surgery are those who have severe elbow arthritis following an injury, especially in young and active individuals who have not responded well to conservative treatments. Additionally, patients who have instability in their elbows before the surgery may not be good candidates for interposition arthroplasty. It is important for patients to discuss their individual case with a healthcare provider to determine if elbow surgery is the best treatment option for them.

Timeline

  • Before surgery: Patients typically experience pain, swelling, and limited range of motion in the affected elbow. They may have tried conservative treatments such as physical therapy, medications, and injections without success. They would have consulted with an orthopedic surgeon to discuss surgical options.

  • Day of surgery: The patient would undergo pre-operative preparations, such as fasting and signing consent forms. The surgery itself would involve the placement of a graft in the elbow joint to improve function and alleviate symptoms.

  • Post-surgery: The patient would wake up in the recovery room with a bandaged and immobilized elbow. They would be given pain medication and instructions on post-operative care, including physical therapy exercises to regain strength and range of motion in the elbow.

  • Weeks to months after surgery: The patient would attend follow-up appointments with their surgeon to monitor healing and progress. Physical therapy would continue to help improve function and prevent stiffness in the elbow. The patient may gradually return to normal activities, taking care to avoid straining the elbow.

  • Long-term follow-up: The patient would continue to follow up with their surgeon periodically to monitor the graft’s survival, check for any complications, and assess overall elbow function. Additional surgeries or treatments may be needed in some cases to address persistent symptoms or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about elbow surgery, specifically interposition arthroplasty, include:

  1. What are the potential risks and complications associated with this procedure?
  2. How long is the recovery period, and what can I expect in terms of pain and rehabilitation?
  3. Will I need physical therapy after the surgery, and for how long?
  4. What is the success rate of this procedure in terms of improving elbow function?
  5. How long will the graft typically last before it may need to be replaced?
  6. Are there any restrictions or limitations I should be aware of after the surgery?
  7. How will you determine if I am a good candidate for interposition arthroplasty?
  8. What alternative treatment options are available, and how do they compare to interposition arthroplasty?
  9. Will I need to undergo any additional surgeries or procedures in the future as a result of this surgery?
  10. What is the expected long-term outcome for patients who undergo this procedure?

Reference

Authors: Lanzerath F, Hackl M, Pucher CJ, Leschinger T, Uschok S, Müller LP, Wegmann K. Journal: Int Orthop. 2022 Nov;46(11):2603-2610. doi: 10.1007/s00264-022-05562-3. Epub 2022 Aug 30. PMID: 36042057