Title : A systematic review of allograft prosthetic composites and mega prostheses for treating massive bone loss in total elbow arthroplasty
Abstract:
Background: Total elbow arthroplasty represents a surgical challenge in the presence of massive bone loss (MBL). The two commonly used techniques to reconstruct MBL around the elbow are allograft-prosthetic composites (APC) and custom or ‘off-the-shelf’ mega prostheses (MP). These are low-volume procedures for which the outcomes have not yet be compared in the published literature. This review aims to compare published outcome data for APC and MP when used to address MBL in the context of TEA.
Methods: A systematic review was performed to identify outcomes for patients treated with APC or MP in TEA. Implant survivorship is presented using Kaplan-Meier analysis. Complication and reoperation rates are presented using narrative synthesis.
Results: A total of 32 studies (322 patients) were eligible for inclusion. There were 147 APCs performed in 139 patients, 15 index procedures and 124 revision procedures; and 193 MPs performed in 183 patients with 144 index and 39 revision procedures. Indications for APC included failed TEA (85%) and tumour (9%). Indications for MP were tumour (69%), failed TEA (14%), and trauma (11%). Overall survivorship was 70% in the APC group, and 77% in the MP group, with a mean follow-up of (24213) and 58 months (1-372) respectively. There was a 37% reoperation rate in the APC group and 24% in the MP group. Foremost complications in the APCs include aseptic loosening 15%, deep infection 7%, and non-union 19%. MP complications include aseptic loosening 11%, deep infection 4%, and local recurrence 5%.
Conclusion: Both APC and MP are viable techniques for addressing MBL in TEA. While MP survivorship and complication rates were superior to APC in this study, these findings must be tempered by substantial differences in the indications for surgery between the techniques and the historic nature of the included studies.
