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Kotze NL, Molony D, Flannery O. Elbow arthroplasty: an Irish perspective. Ir J Med Sci 2025:10.1007/s11845-025-03960-1. [PMID: 40310497 DOI: 10.1007/s11845-025-03960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/23/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Elbow arthroplasty (EA) aims to restore function and alleviate pain in the elbow joint. Research shows that a higher volume of EAs performed by surgeons and surgical centres correlates with decreased complications, reduced revision rates, and lower healthcare costs. AIMS This study aims to determine the current landscape of elbow arthroplasty in Ireland. METHOD A retrospective cross-sectional study was conducted through surveys distributed to upper limb surgeons in Ireland who performed EAs from October 2022 to October 2024. The survey sought to gather data on the number of procedures completed in the 2-year window. Additionally, it probed surgeons' intentions to continue performing these surgeries and their views on the necessary number of surgeons for adequate service provision in Ireland. RESULTS Nineteen surgeons participated, performing a total of 97 elbow arthroplasties over 2 years, which translates to a median of 4 procedures per surgeon (approximately 2 annually). The cohort included 32% distal humerus hemiarthroplasties (DHHs) and 68% total elbow arthroplasties (TEAs), with 60% classified as elective and 40% as trauma-related. All participants indicated a desire to continue performing these procedures. CONCLUSION The low volume of elbow arthroplasty procedures in Ireland underscores the necessity for a national policy focused on enhancing surgical quality and patient outcomes. The insights gained from this data aim to stimulate discussions among elbow surgeons in Ireland, paving the way for effective policy implementation.
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Affiliation(s)
| | - Diarmuid Molony
- Tallaght University Hospital, Dublin, Ireland
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Olivia Flannery
- Connolly Hospital Blanchardstown, Dublin, Ireland
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
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Al-Hamdani A, Rasmussen JV, Al-Hamdani MA, Sørensen AKB, Eschen J, Olsen BS. The Copenhagen Classification System for Distal Humeral Fractures is useful to identify patients who may require treatment with hemi- or total elbow arthroplasty. JSES Int 2024; 8:915-920. [PMID: 39035674 PMCID: PMC11258849 DOI: 10.1016/j.jseint.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Classification systems are only useful if there is agreement among observers. The purpose of this study is to introduce a simple and clinically applicable classification system - The Copenhagen Classification System for Distal Humeral Fractures (CCDHF) and to compare the interobserver and intraobserver agreement for this classification with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA), and the Sheffield classification systems. The primary objective of the new classification system is to distinguish fractures that may not be suitable for open reduction and internal fixation, necessitating treatment options such as elbow hemiarthroplasty or total elbow arthroplasty (TEA). Methods Five consultant elbow surgeons assessed a consecutive series of 105 sets X-rays of distal humeral fractures on 2 occasions with at least 10 weeks interval. All X-rays were classified according to AO/OTA, Sheffield, and the CCDHF systems. The CCDHF system has been developed collaboratively by a panel of five experienced elbow surgeons. Based on consensus, the surgeons identified specific fracture characteristics where elbow hemiarthroplasty or TEA might be needed. Results The mean interobserver agreement was fair for AO/OTA and moderate for Sheffield and the CCDHF. The mean intraobserver agreement was moderate for AO/OTA and substantial for Sheffield and the CCDHF. The observers were uncertain about the classification in 29% of the cases with the AO/OTA classification, 15% with the Sheffield classification, and 12% with CCDHF. Conclusion The CCDHF demonstrated validity and clinical applicability and can assist surgeons in identifying fractures that may require hemiarthroplasty or TEA treatment.
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Affiliation(s)
- Ali Al-Hamdani
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jeppe V. Rasmussen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Kathrine B. Sørensen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eschen
- Department of Orthopaedic Surgery, Privathospitalet Danmark, Copenhagen, Denmark
| | - Bo S. Olsen
- Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Al-Hamdani A, Macken A, Prkic A, The B, Spekenbrink-Spooren A, Eygendaal D. Analysis of 516 cases of revision total elbow arthroplasty from the Dutch Arthroplasty Registry: centralization of care is the future. SEMINARS IN ARTHROPLASTY: JSES 2024; 34:430-435. [DOI: 10.1053/j.sart.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Hamoodi Z, Gehringer CK, Bull LM, Hughes T, Kearsley-Fleet L, Sergeant JC, Watts AC. Prognostic factors associated with failure of total elbow arthroplasty. Bone Joint Res 2024; 13:201-213. [PMID: 38688503 PMCID: PMC11060869 DOI: 10.1302/2046-3758.135.bjr-2023-0281.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Aims The aims of this study were to identify and evaluate the current literature examining the prognostic factors which are associated with failure of total elbow arthroplasty (TEA). Methods Electronic literature searches were conducted using MEDLINE, Embase, PubMed, and Cochrane. All studies reporting prognostic estimates for factors associated with the revision of a primary TEA were included. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and the quality of evidence was assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Due to low quality of the evidence and the heterogeneous nature of the studies, a narrative synthesis was used. Results A total of 19 studies met the inclusion criteria, investigating 28 possible prognostic factors. Most QUIPS domains (84%) were rated as moderate to high risk of bias. The quality of the evidence was low or very low for all prognostic factors. In low-quality evidence, prognostic factors with consistent associations with failure of TEA in more than one study were: the sequelae of trauma leading to TEA, either independently or combined with acute trauma, and male sex. Several other studies investigating sex reported no association. The evidence for other factors was of very low quality and mostly involved exploratory studies. Conclusion The current evidence investigating the prognostic factors associated with failure of TEA is of low or very low quality, and studies generally have a moderate to high risk of bias. Prognostic factors are subject to uncertainty, should be interpreted with caution, and are of little clinical value. Higher-quality evidence is required to determine robust prognostic factors for failure of TEA.
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Affiliation(s)
- Zaid Hamoodi
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Upper Limb Unit, Wrightington Hospital, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Celina K. Gehringer
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Tom Hughes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jamie C. Sergeant
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Adam C. Watts
- Upper Limb Unit, Wrightington Hospital, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
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Macken AA, Prkić A, van Oost I, Spekenbrink-Spooren A, The B, Eygendaal D. Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry. Bone Jt Open 2023; 4:110-119. [PMID: 37051858 PMCID: PMC9999123 DOI: 10.1302/2633-1462.42.bjo-2022-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statistically significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions.
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Affiliation(s)
- Arno A. Macken
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Ante Prkić
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Iris van Oost
- Foundation for Orthopaedic Research Care & Education (FORCE), Amphia Hospital, Breda, the Netherlands
| | | | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
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Kunkle BF, Baxter NA, Welsh ME, Friedman RJ, Eichinger JK. Identification of Independent Predictors of Increased 90-Day Complication and Revision Rates Following Total Elbow Arthroplasty. J Shoulder Elb Arthroplast 2023; 7:24715492231152146. [PMID: 36727143 PMCID: PMC9884946 DOI: 10.1177/24715492231152146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Total elbow arthroplasty (TEA) is an increasingly popular surgical option for many debilitating conditions of the elbow. There currently exists a paucity of literature regarding patient and hospital factors that lead to inferior outcomes following TEA. The purpose of this study is to identify independent predictors of increased complication and revision rates following TEA. Methods The National Readmissions Database (NRD) was queried from 2011 to 2018 to identify all cases of TEA (n = 8932). Relevant patient demographic factors, comorbidities, and hospital characteristics were identified and run in a univariate binomial logistic regression model. All significant variables were included in a multivariate binomial logistic regression model for data analysis. Results Independent predictors of increased complication rates included age, female sex, Medicare and Medicaid payer status, medium bed-sized center, and 18 of 34 medical comorbidities (all P < .05). Independent predictors of increased revision rates included medium bed-sized centers, non-teaching hospital status, chronic pulmonary disease, depression, and pulmonary circulatory disorders (all P < .05). Conclusion This study identified several patient and hospital characteristics that are independently associated with both increased complication and revision rates following TEA. This information can aid orthopedic surgeons during shared decision making when considering TEA in patients. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Bryce F Kunkle
- Medical University of South
Carolina, Charleston, SC, USA
| | | | - Megan E Welsh
- Medical University of South
Carolina, Charleston, SC, USA
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Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons. JSES Int 2022; 7:178-185. [PMID: 36820421 PMCID: PMC9937840 DOI: 10.1016/j.jseint.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The purpose of this investigation was to assess surgical outcomes after distal biceps tendon (DBT) repair for upper-extremity surgeons at the beginning of their careers, immediately following fellowship training. We aimed to determine if procedure times, complication rates, and clinical outcomes differed during the learning curve period for these early-career surgeons. Methods All cases of DBT repairs performed by 2 fellowship-trained surgeons from the start of their careers were included. Demographic data as well as operative times, complication rates, and patient reported outcomes were retrospectively collected. A cumulative sum chart (CUSUM) analysis was performed for the learning curve for both operative times and complication rate. This analysis continuously compares performance of an outcome to a predefined target level. Results A total of 78 DBT repairs performed by the two surgeons were included. In the CUSUM analysis of operative time for surgeon 1 and 2, both demonstrated a learning curve until case 4. In CUSUM analysis for complication rates, neither surgeon 1 nor surgeon 2 performed significantly worse than the target value and learning curve ranged from 14 to 21 cases. Mean Disabilities of Arm, Shoulder, and Hand score (QuickDASH) (10.65 ± 5.81) and the pain visual analog scale scores (1.13 ± 2.04) were comparable to previously reported literature. Conclusions These data suggest that a learning curve between 4 and 20 cases exists with respect to operative times and complication rates for DBT repairs for fellowship-trained upper-extremity surgeons at the start of clinical practice. Early-career surgeons appear to have acceptable clinical results and complications relative to previously published series irrespective of their learning stage.
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