INTERPOSITION-ARTHROPLASTY OF THE ELBOW: SYSTEMATIC REVIEW

The research was carried out by three independent researchers, in the databases PubMed, Medline and Embase, according to the descriptors selected as a research strategy and filters selected in the inclusion criteria.

Results:

In total, 21 studies were found with the afore mentioned descriptors and which were considered adequate according to the design and relevance according to the type of study and inclusion filters. There was a very strong correlation between the searches of the three researchers (k = 0.809). At the end, 14 complete studies were presented, all of which were included.

Conclusion:

The main finding of this study was to note that there is an evident lack of research with a high level of real effectiveness and indication for interposition arthroplasty in the rigid elbow. Most studies point to positive results when the patient is young and a total arthroplasty is not indicated. No meta-analysis or randomized clinical trial was found for this specific topic, despite being a technique applied in clinical practice for some decades and showing good results. Level of Evidence V, Systematic Review.

Keywords:
Arthroplasty; Elbow; Treatment Outcome

Study	Study design	Age group	Follow-up time	Clinical outcome
Burkhart et al.²2. Burkhart KJ, Hollinger B. [Post-traumatic arthritis in the young patient: treatment options before the endoprosthesis]. Orthopade. 2016;45(10):832-43.	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.³3. Chauhan A, Palmer BA, Baratz ME. Arthroscopically assisted elbow interposition arthroplasty without hinged external fixation: surgical technique and patient outcomes. J Shoulder Elbow Surg. 2015;24(6):947-54.	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.¹⁵15. 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 Orthop Traumatol Turc. 2014;48(5):558-62	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.⁴4. 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(11):704-14.	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.⁵5. Kokkalis ZT, Schmidt CC, Sotereanos DG. Elbow arthritis: current concepts. J Hand Surg Am. 2009;34(4):761-8.	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.⁶6. Miyazaki AN, Fregoneze M, Santos PD, Silva LA, Gennaro N Jr, Checchia SL. Tratamento do cotovelo rígido com artroplastia de interposição associada ao fixador externo articulado. Rev Bras Ortop. 2009;44(4):336-41.	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.⁷7. 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(3):459-64.	Case series	Not described	7 years	They obtained good results in elbow extension
Cheung et al.⁸8. Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg. 2008;16(2):77-87.	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 Morrey⁹9. 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(12):2714-23.	Case series	Young patients	Not described	They observed that the most suitable for interposition arthroplasty were those patients who had post-traumatic elbow arthrosis
Neidel¹⁰10. Neidel J. [Interposition-arthroplasty of the elbow in a child as delayed treatment of an unreduced multifragmentary fracture of the distal humerus: result after 77 years: case report and review of the literature]. Z Orthop Ihre Grenzgeb. 2002;140(3):355-7.	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.
Mansat¹¹11. Mansat P. Surgical treatment of the rheumatoid elbow. Joint Bone Spine. 2001;68(3):198-210.	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
Lee¹²12. Lee DH. Posttraumatic elbow arthritis and arthroplasty. Orthop Clin North Am. 1999;30(1):141-62.	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.¹³13. Ljung P, Jonsson K, Larsson K, Rydholm U. Interposition arthroplasty of the elbow with rheumatoid arthritis. J Shoulder Elbow Surg. 1996;5(2):81-5.	Case series	Young patients	Not described	The authors suggested total elbow arthroplasty as the initial treatment for rheumatoid arthritis
Morrey¹⁴14. Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am. 1990;72(4):601-18.	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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[1] Correspondence:
Thiago Bernardo Carvalho de Almeida. Rua Marcel Preotesco 134, apto 123, torre B, São Bernardo do Campo, SP, Brazil, 09750225. dr.tbca@hotmail.com