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Radial head arthroplasty: a descriptive study of 970 patients in an integrated health care system.
Foroohar, Abtin; Prentice, Heather A; Burfeind, William E; Navarro, Ronald A; Mirzayan, Raffy; Zeltser, David W.
Afiliação
  • Foroohar A; Department of Orthopedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA.
  • Prentice HA; Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA. Electronic address: Heather.Prentice@kp.org.
  • Burfeind WE; Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA.
  • Navarro RA; Department of Orthopedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA.
  • Mirzayan R; Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
  • Zeltser DW; Department of Orthopedic Surgery, The Permanente Medical Group, San Francisco, CA, USA.
J Shoulder Elbow Surg ; 31(6): 1242-1253, 2022 Jun.
Article em En | MEDLINE | ID: mdl-35093522
BACKGROUND: Radial head arthroplasty (RHA) is commonly performed for isolated comminuted radial head fractures and in conjunction with traumatic elbow instability. However, there is a paucity of literature directly describing the characteristics and outcomes of patients who undergo RHA in a community-based setting. We describe a cohort of 970 RHA performed in the California regions of a US integrated health care system over a 9-year period. Patient demographics, implant selection, 90-day acute postoperative events, and cumulative reoperation/revision rates are included. METHODS: Patients aged ≥18 years who underwent primary RHA were identified (2009-2017). Patient characteristics and demographics, including age, body mass index, gender, diabetes status, American Society of Anesthesiologists (ASA) classification, primary diagnosis, and concomitant procedures were described. Crude cumulative revision and reoperation probabilities were calculated as 1 minus the Kaplan-Meier estimator, with follow-up time calculated as the time from the index RHA to revision/reoperation date for those with the outcome of interest and time from index RHA to censoring date (eg, date of death, health care termination, study end date [March 31, 2018]) for those without the outcome. Ninety-day postoperative incidence of emergency department (ED) visit, readmission, and mortality was calculated as the number of patients with the event of interest over the number of patients at risk. RESULTS: A total of 970 patients underwent primary unilateral RHA by 205 surgeons during the study period. Annual procedure volume increased from 53 procedures in 2009 to 157 procedures in 2017. More patients were female, without diabetes, and had an ASA classification of 1 or 2. Fracture was the predominant indication for RHA (98.4%) and more than half (54.3%) had concomitant procedures performed. Most implants were press fit (63.2%) over loose fit, and >90% were monopolar. Three-year cumulative revision and reoperation probabilities following RHA were 6.5% (95% confidence interval [CI] = 5.0%-8.5%) and 8.2% (95% CI = 6.5%-10.3%), respectively. Revisions and reoperations tended to occur within the first postoperative year. Of the 970 RHA patients, 83 (8.5%) had a 90-day ED visit, 58 (6.0%) had a 90-day readmission, and 1 (0.1%) died within a 90-day postoperative period. CONCLUSION: This large cohort of RHA patients provides information about the practice of RHA at large and in the community. Surgeons are performing more RHA over time and choosing press fit stems more often. Revisions and reoperations tended to occur early. Readmission and ED visits were low but not negligible, with pain being the most common reason for ED visit.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Prestação Integrada de Cuidados de Saúde / Articulação do Cotovelo / Instabilidade Articular Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Shoulder Elbow Surg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Prestação Integrada de Cuidados de Saúde / Articulação do Cotovelo / Instabilidade Articular Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Shoulder Elbow Surg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos