ARTROPLASTIA DE INTERPOSIÇÃO EM COTOVELO: REVISÃO SISTEMÁTICA

ALMEIDA, THIAGO BERNARDO CARVALHO DE; REIS, EDMILSON DA SILVA; PASCARELLI, LUCIANO; BONGIOVANNI, ROBERTO RANGEL; TEODORO, RENATO LOUREIRO

doi:10.1590/1413-785220212904238960

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REVIEW ARTICLE, SHOULDER AND ELBOW • Acta ortop. bras. 29 (4) • Jul-Aug 2021 • https://doi.org/10.1590/1413-785220212904238960 linkcopiar

ARTROPLASTIA DE INTERPOSIÇÃO EM COTOVELO: REVISÃO SISTEMÁTICA

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Realizar uma revisão sistemática dos principais métodos e indicações da artroplastia de interposição em cotovelo rígido.

Métodos: Pesquisa realizada por três pesquisadores independentes nas bases de dados PubMed, Medline e Embase, segundo os descritores selecionados como estratégia de busca e filtros estabelecidos nos critérios de inclusão.

Resultados: Foram encontrados 21 estudos com os descritores selecionados, que foram avaliados conforme seu desenho e relevância segundo os filtros do tipo de estudo e critérios de inclusão. Houve correlação muito forte entre as buscas dos três pesquisadores (k = 0,809). Ao final, restaram 14 estudos completos, e todos foram incluídos.

Conclusão: Observou-se que existe uma carência evidente de pesquisas com nível de confiabilidade alto para a real eficácia e indicação da artroplastia de interposição no cotovelo rígido. A maioria dos trabalhos aponta para resultados positivos quando o paciente é jovem e a artroplastia total não é indicada. Não foi encontrada nenhuma metanálise ou ensaio clínico randomizado para esse tema específico, apesar de ser uma técnica aplicada na prática clínica há algumas décadas e que apresenta bons resultados. Nível de Evidência V, Revisão Sistemática.

Descritores:
Artroplastia; Cotovelo; Resultado do Tratamento

Study	Study design	Age group	Follow-up time	Clinical outcome
Burkhart et al.²	Review	Young adult	Not described	Interposition arthroplasty preserves the revision options of reinterposition arthroplasty, as well as the withdrawal of total elbow arthroplasty
Chauhan et al.³	Case series	Average age 57 years old	Average follow-up:3.6 years	An arthroscopically assisted elbow interposition arthroplasty without external hinged fixation can provide satisfactory mid-term results as a rescue procedure for a difficult condition with limited options
Ersen et al.¹⁵	Case series	31 years average	87 months	Interposition arthroplasty is a rescue procedure that appears to have good long-term functional results, especially in patients for whom elbow arthroplasty is not suitable. The use of an Achilles allograft for interposition can protect the joint space in the long term.
Sears et al.⁴	Review	Young and active population	1 year	Patients who report stiffness and pain at the end of movement may benefit from arthroscopic or open osteocapsular debridement. Those with advanced degenerative changes and pain across the range of motion may require joint restoration with interposition arthroplasty
Kokkalis et al.⁵	Review	Young adults	Not Reported	Arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young, active patient population.
Miyazaki et al.⁶	Case series	Average 38 years	54 months	Interposition arthroplasty with fascia lata associated with the use of a dynamic external fixator in stiff elbow is a viable alternative for patients who do not have an indication for total elbow arthroplasty
Nolla et al.⁷	Case series	Not described	7 years	They obtained good results in elbow extension
Cheung et al.⁸	Review	Young population	Not described	In young patients with primary osteoarthritis, interposition arthroplasty is a valid option, although arthroscopic debridement has been presented as one of the main advances in these cases today.
Larson and Morrey⁹	Case series	Young patients	Not described	They observed that the most suitable for interposition arthroplasty were those patients who had post-traumatic elbow arthrosis
Neidel¹⁰	Case report	10 years	77 years	Interposition arthroplasty in multifractures of the elbow was a technique chosen due to the patient’s age and presented definitive and positive results.
Mansat¹¹	Review	Not described specific age group	Not Reported	In the surgical treatment of rheumatoid elbow, interposition arthroplasty is a valid option before total arthroplasty, especially in young and severely affected patients
Lee¹²	Report of 3 cases	Young patients	7.6 years	An increased mean range of motion of 65 degrees was achieved in flexion and extension in two patients and a more functional range in the third. Although this is seen as a rescue procedure in patients who are thought to be too young for elbow arthroplasty, none of the three patients experienced significant pain and none required total elbow arthroplasty after a mean follow-up of 7.6 years
Ljung et al.¹³	Case series	Young patients	Not described	The authors suggested total elbow arthroplasty as the initial treatment for rheumatoid arthritis
Morrey¹⁴	Case series	Not described	94 months	The results of interposition arthroplasty can be gratifying, but the technique is demanding and the complication rate is high.

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