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Sert dirsek: Aşil tendon allogrefti ile yapılan distraksiyon interpozisyon artroplastisi: Uzun dönem radyolojik ve fonksiyonel sonuçlar

Year 2014, , 558 - 562, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0131

Abstract

Amaç: Bu çalışmada Aşil tendon allogrefti kullanılarak yapılan distraksiyon interpozisyon artroplastisinin uzun dönem radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlandı.

Çalışma planı: 2001-2010 yılları arasında intrensek kaynaklı dirsek sertliği ve artrozu nedeniyle distraksiyon interpozisyon artroplastisi uygulanan 5 hasta (3 kadın, 2 erkek; ortalama yaş: 31, dağılım: 25-41) çalışmaya alındı. Tüm hastalarda taze donmuş Aşil allogrefti ile interpozisyon ve kollateral bağ rekonstrüksiyonu uygulandı. Hastaların ortalama takip süresi 87.6 (dağılım: 40-131) ay idi. Eksternal fiksatörle distraksiyon ortalama 7 (dağılım: 6-8) hafta uygulandı. Tüm hastalara ameliyattan sonra 1. gün dirsek hareketine başlandı. Hastaların ameliyat öncesi ve sonrası radyolojik değerlendirmeleri yapıldı. Yine, ameliyat öncesi ve sonrası, hastaların dirsek eklemi hareket açıklığı, Mayo Dirsek Performans Skoru ve DASH skorları ölçülerek fonksiyonel değerlendirmeleri yapıldı.

Bulgular: Hastaların ameliyat öncesi ortalama fleksiyon–ekstansiyon arkı 24° (dağılım: 0°-80°), supinasyon-pronasyon arkı 15° idi. İki hastanın ameliyat öncesi muayenesinde 90° ve 60° fleksiyonda dirsek ankilozu mevcuttu. Son kontrollerde ortalama fleksiyon-ekstansiyon arkının anlamlı olarak 81 dereceye (dağılım: 50°-110°) yükseldiği görüldü (p<0.05). Ameliyat öncesi ortalama 75.3 (dağılım: 53-89) olan DASH skoru, ameliyat sonrasında 18.9’a (dağılım: 6.7-45.8) yükseldi (p<0.05). Yine ameliyat öncesi ortalama 25 (dağılım: 20-35) puan ile kötü olarak nitelenen MDPS, son kontrollerde ortalama 71 (dağılım: 70-75) puan ile 4 hastada iyi, 1 hastada ise orta olarak belirlendi (p<0.05). Hastaların son muayenelerinde dirseklerinde instabilite görülmezken, hiçbir hastada revizyon cerrahisine ihtiyaç olmadı.

Çıkarımlar: Distraksiyon interpozisyon artroplastisi, özellikle dirsek artroplastisinin uygun olmadığı hasta grubunda fonksiyonel anlamda uzun dönemde iyi sonuçlar veren kurtarıcı bir girişimdir. İnterpozisyon amacıyla kullanılan Aşil allogrefti eklem aralığını uzun dönemde koruyabilmektedir.

References

  • Sears BW, Puskas GJ, Morrey ME, Sanchez-Sotelo J, Morrey BF. Posttraumatic elbow arthritis in the young adult: evaluation and management. J Am Acad Orthop Surg 2012;20:704-14.
  • Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 1990;72:601-18.
  • Ljung P, Jonsson K, Larsson K, Rydholm U. Interposition arthroplasty of the elbow with rheumatoid arthritis. J Shoulder Elbow Surg 1996;5:81-5.
  • Larson AN, Morrey BF. Interposition arthroplasty with an Achilles tendon allograft as a salvage procedure for the elbow. J Bone Joint Surg Am 2008;90:2714-23. Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg 2008;16:77-87.
  • Cheng SL, Morrey BF. Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty. J Bone Joint Surg Br 2000;82:233-8.
  • Nolla J, Ring D, Lozano-Calderon S, Jupiter JB. Interposition arthroplasty of the elbow with hinged external fixation for post-traumatic arthritis. J Shoulder Elbow Surg 2008;17:459-64.
  • Kita M. Arthroplasty of the elbow using J-K membrane. An analysis of 31 cases. Acta Orthop Scand 1977;48:450
  • Blaine TA, Adams R, Morrey BF. Total elbow arthroplasty after interposition arthroplasty for elbow arthritis. J Bone Joint Surg Am 2005;87:286-92.

Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results

Year 2014, , 558 - 562, 12.11.2014
https://doi.org/10.3944/AOTT.2014.14.0131

Abstract

Objective: The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft.

Methods: The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients. Mean follow-up period was 87.6 (range: 40 to 131) months. Mean distraction time with an external fixator was 7 (range: 6 to 8) weeks. Elbow motion was allowed in the first postoperative day in all patients. Radiological evaluation was performed pre- and postoperatively. Elbow ROM, and the Mayo Elbow Performance Score (MEPS) and DASH scores were recorded for functional evaluation.

Results: Mean preoperative flexion-extension range was 24° (range: 0° to 80°) and mean supination-pronation range was 15°. Two patients had elbow ankylosis in 90° and 60° of flexion at the preoperative examination. Mean postoperative flexion-extension range increased significantly to 81° (range: 50° to 110°) (p<0.05). Mean preoperative DASH score improved from 75.3 (range: 53 to 89) to 18.9 (range: 6.7 to 45.8) postoperatively (p<0.05). Mean postoperative MEPS were poor (mean: 25, range: 20 to 35) while postoperative MEPS were good (mean: 71, range: 70 to 75) in 4 patients and fair in 1 (p<0.05). No patient experienced elbow instability at the final follow-up and none required revision.

Conclusion: Distraction interposition arthroplasty is a salvage procedure which appears to have good long-term functional results, especially in patients in which elbow arthroplasty is not suitable. The use of Achilles allograft for interposition can protect the joint space in the long-term.

References

  • Sears BW, Puskas GJ, Morrey ME, Sanchez-Sotelo J, Morrey BF. Posttraumatic elbow arthritis in the young adult: evaluation and management. J Am Acad Orthop Surg 2012;20:704-14.
  • Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 1990;72:601-18.
  • Ljung P, Jonsson K, Larsson K, Rydholm U. Interposition arthroplasty of the elbow with rheumatoid arthritis. J Shoulder Elbow Surg 1996;5:81-5.
  • Larson AN, Morrey BF. Interposition arthroplasty with an Achilles tendon allograft as a salvage procedure for the elbow. J Bone Joint Surg Am 2008;90:2714-23. Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg 2008;16:77-87.
  • Cheng SL, Morrey BF. Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty. J Bone Joint Surg Br 2000;82:233-8.
  • Nolla J, Ring D, Lozano-Calderon S, Jupiter JB. Interposition arthroplasty of the elbow with hinged external fixation for post-traumatic arthritis. J Shoulder Elbow Surg 2008;17:459-64.
  • Kita M. Arthroplasty of the elbow using J-K membrane. An analysis of 31 cases. Acta Orthop Scand 1977;48:450
  • Blaine TA, Adams R, Morrey BF. Total elbow arthroplasty after interposition arthroplasty for elbow arthritis. J Bone Joint Surg Am 2005;87:286-92.
There are 8 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Ali Ersen This is me

Mehmet Demirhan This is me

Ata Can Atalar This is me

Ahmet Salduz This is me

Onur Tunali This is me

Publication Date November 12, 2014
Published in Issue Year 2014

Cite

APA Ersen, A., Demirhan, M., Atalar, A. C., Salduz, A., et al. (2014). Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthopaedica Et Traumatologica Turcica, 48(5), 558-562. https://doi.org/10.3944/AOTT.2014.14.0131
AMA Ersen A, Demirhan M, Atalar AC, Salduz A, Tunali O. Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthopaedica et Traumatologica Turcica. November 2014;48(5):558-562. doi:10.3944/AOTT.2014.14.0131
Chicago Ersen, Ali, Mehmet Demirhan, Ata Can Atalar, Ahmet Salduz, and Onur Tunali. “Stiff Elbow: Distraction Interposition Arthroplasty With an Achilles Tendon Allograft: Long-Term Radiological and Functional Results”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 5 (November 2014): 558-62. https://doi.org/10.3944/AOTT.2014.14.0131.
EndNote Ersen A, Demirhan M, Atalar AC, Salduz A, Tunali O (November 1, 2014) Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthopaedica et Traumatologica Turcica 48 5 558–562.
IEEE A. Ersen, M. Demirhan, A. C. Atalar, A. Salduz, and O. Tunali, “Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 5, pp. 558–562, 2014, doi: 10.3944/AOTT.2014.14.0131.
ISNAD Ersen, Ali et al. “Stiff Elbow: Distraction Interposition Arthroplasty With an Achilles Tendon Allograft: Long-Term Radiological and Functional Results”. Acta Orthopaedica et Traumatologica Turcica 48/5 (November 2014), 558-562. https://doi.org/10.3944/AOTT.2014.14.0131.
JAMA Ersen A, Demirhan M, Atalar AC, Salduz A, Tunali O. Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthopaedica et Traumatologica Turcica. 2014;48:558–562.
MLA Ersen, Ali et al. “Stiff Elbow: Distraction Interposition Arthroplasty With an Achilles Tendon Allograft: Long-Term Radiological and Functional Results”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 5, 2014, pp. 558-62, doi:10.3944/AOTT.2014.14.0131.
Vancouver Ersen A, Demirhan M, Atalar AC, Salduz A, Tunali O. Stiff elbow: Distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta Orthopaedica et Traumatologica Turcica. 2014;48(5):558-62.