Elbow joint position sense after total elbow arthroplasty.

BACKGROUND: Multiple human experiments have shown that articular lesions can have a negative effect on proprioception. The influence of total elbow arthroplasty on joint position sense has not been reported so far. The purpose of the study was to evaluate proprioception, defined as a joint position sense, after total elbow arthroplasty. METHODS: The study included 16 patients with unilateral semiconstrained linked total elbow arthroplasty and 21 healthy volunteers. The evaluation included measurement of active and passive reproduction of joint position sense of both elbows after surgery and the control groups. Reference angles included extension to 50° and 70° and flexion to 110°. We also assessed function of the elbow in arthroplasty group using the Mayo Elbow Performance Score, the Disability of the Arm, Shoulder and Hand score, and a visual analog scale for pain level. RESULTS: The average value of error of passive reproduction of joint position for elbows after arthroplasty was significantly inferior for all evaluated positions compared with the contralateral elbow and with the control group, respectively, at 110° flexion: 4.3°, 2.7°, and 3.2°; at 70° extension: 4.9°, 2.9°, and 2.7°; and at 50° extension: 6.3°, 3.8°, and 3.8°. The average value of error of active reproduction of joint position for the arthroplasty group was also significantly inferior, respectively, at 110° flexion: 3.5°, 1.9° and 2°; and at 50° extension: 4.4°, 3.3°, and 3°. CONCLUSION: Proprioception in elbows that undergo total arthroplasty is significantly inferior compared with the contralateral site of the patient and in the healthy control group.

Clinical and functional evaluation of patients after total elbow arthroplasty.

BACKGROUND: The operation of the total elbow arthroplasty (TEA) is recommended in case of advanced joint destruction. At present both in our country and abroad, the number of elbow arthroplasties performed per year is increasing. Surgical procedures are difficult, and postoperative complications may arise. The aim of this study is to evaluate the function of the elbow and the clinical status of patients after having undergone TEA. MATERIAL/METHODS: Our research is based on 18 patients who had undergone total elbow arthroplasty. The average patient age was 60. The follow-up time varied from 8-108 months. Postoperative assessment included the evaluation of the range of motion and grip strength using a dynamometer. Functional evaluation was carried out using Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) and the SECEC Elbow Score (SES). We had also assessed the pain level (VAS), postoperative complications and patient satisfaction. The study included X-rays of the elbow for the evaluation of prosthesis integrity and possible signs of implant loosening. RESULTS: The increase of the range of motion was seen among all patients. The amplitude of flexion and extension increased by an average of 25.3° (p<0.02). The results of all questionnaires of functional assessment showed a significant improvement comparing to results before surgery: DASH - 82.6 (±24.6) vs. 116.7 (±24.2), SECEC - 39.3 (±8.5) vs. 27.9 (±9.2), MEPS - 65 (±23.3) vs. 35.8 (±16.9). The VAS pain decreased from 10.9 (±3) to 5.3 (±4). In the postoperative period, 4 patients experienced inflammation, 2 patients had a loosening of prosthesis, and 6 needed a revision of the prosthesis. 94.4% patients were satisfied with the treatment. CONCLUSIONS: Total elbow arthroplasty effectively improves the clinical status of the patient by reducing pain, increasing range of motion and improving many activities of daily life.