Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: a retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation

Background: The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures with those of secondary total elbow arthroplasty after failed internal fixation. The secondary objective was to compare the complication rates and the radiographic results in the 2 groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed after failed internal fixation were comparable to those of primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population. Methods: We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85 years), who either underwent a primary total elbow arthroplasty (group 1; 45 patients) or secondary total elbow arthroplasty after failed internal fixation (group 2; 15 patients) in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including the Mayo Elbow Performance Score and triceps proficiency test, complication rates, and the need for reoperation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120 months). Results: The clinical results of the 2 groups were comparable when looking at the Mayo Elbow Performance Score (90.00 [85.00, 100.00], P = .486). With regard to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (P = .099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (P = .448), and 1 patient with triceps insufficiency in group 1. Conclusions: Secondary total elbow arthroplasty after failed internal fixation has shown good functional results and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly. Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study (c) 2024 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).