Revision total elbow arthroplasty (TEA) is indicated for component loosening, periprosthetic joint infection, and fractures. Previous investigations into revision TEA complications have small sample sizes and limited exploration of acute complications. This study aims to characterize the 30-day complications and associated demographics of patients undergoing revision TEA using a large national database.
Methods
The 2015–2020 American College of Surgeons National Surgical Quality Improvement Program database was used to identify all revision TEA patients.
Results
The analysis included 158 patients (average age 62.6 years). The overall complication rate was 13.9% (n = 22). The most common 30-day complications were organ/space surgical site infection (3.8%, n = 6), unplanned readmission (3.2%, n = 5), intraoperative or postoperative transfusion (3.2%, n = 5), and unplanned reoperation (1.9%, n = 3). Patients with a history of dyspnea or steroid/immunosuppressant use for a chronic condition had significantly higher rates of bleeding requiring transfusion (p = .029 and p = .021, respectively). Additionally, patients aged 80 years or older had a significantly higher rate of unplanned readmission (p = .032).
Conclusion
Revision TEA has a 13.9% rate of complications within 30-days of surgery, with most involving surgical site infection, unplanned readmission, and blood transfusion.
KiranMJariwalaAWigderowitzC. Medium term outcomes of primary and revision Coonrad-Morrey total elbow replacement. Indian J Orthop2015; 49: 233–238.
6.
ViveenJPrkicAKoenraadtKLM, et al.Clinical and radiographic outcome of revision surgery of total elbow prosthesis: midterm results in 19 cases. J Shoulder Elbow Surg2017; 26: 716–722.
7.
de VosMJWagenerMLHanninkG, et al.Short-term clinical results of revision elbow arthroplasty using the latitude total elbow arthroplasty. Bone Jt J2016; 98-B: 1086–1092.
8.
PlaschkeHCThillemannTMBrorsonS, et al.Outcome after total elbow arthroplasty: a retrospective study of 167 procedures performed from 1981 to 2008. J Shoulder Elbow Surg2015; 24: 1982–1990.
9.
BarretHLaumoneriePDelclauxS, et al.Revision total elbow arthroplasty with the semiconstrained Coonrad/Morrey prosthesis: follow-up to 21 years. J Bone Joint Surg Am2021; 103: 618–628.
10.
DeBernardisDAHorneffJGDavisDE, et al.Revision total elbow arthroplasty failure rates: the impact of primary arthroplasty failure etiology on subsequent revisions. J Shoulder Elbow Surg2020; 29: 321–328.
11.
KoCYHallBLHartAJ, et al.The American college of surgeons national surgical quality improvement program: achieving better and safer surgery. Jt Comm J Qual Patient Saf2015; 41: 199–204.
12.
MedlineAMuralidharanVJCodnerJ, et al.Organ-space surgical site infections: consequences and prediction using ACS-NSQIP. Am Surg2022; 88: 1773–1782.
13.
RavalMVPawlikTM. Practical guide to surgical data sets: national surgical quality improvement program (NSQIP) and pediatric NSQIP. JAMA Surg2018; 153: 764–765.
14.
DavisCLPierceJRHendersonW, et al.Assessment of the reliability of data collected for the department of veterans affairs national surgical quality improvement program. J Am Coll Surg2007; 204: 550–560.
15.
HuffmanKMCohenMEKoCY, et al.A comprehensive evaluation of statistical reliability in ACS NSQIP profiling models. Ann Surg2015; 261: 1108–1113.
16.
ShiloachMFrencherSKJSteegerJE, et al.Toward robust information: data quality and inter-rater reliability in the American college of surgeons national surgical quality improvement program. J Am Coll Surg2010; 210: 6–16.
17.
PrangeFSeifertAPiakongP, et al.Short-term mortality after primary and revision total joint arthroplasty: a single-center analysis of 103,560 patients. Arch Orthop Trauma Surg2021; 141: 517–525.
18.
BohlDDSamuelAMBasquesBA, et al.How much do adverse event rates differ between primary and revision total joint arthroplasty?J Arthroplasty2016; 31: 596–602.
19.
LübbekeAKatzJNPernegerTV, et al.Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol2007; 34: 394–400.
20.
SaltzmanBMChalmersPNGuptaAK, et al.Complication rates comparing primary with revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg2014; 23: 1647–1654.
21.
KwakJ-MKholinneESunY, et al.Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty. Int Orthop2019; 43: 1421–1427.
22.
ShiLLZurakowskiDJonesDG, et al.Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Joint Surg Am2007; 89: 1467–1475.
23.
ZeltserDWPrenticeHANavarroRA, et al.Total elbow arthroplasty: a descriptive analysis of 170 patients from a United States integrated health care system. J Hand Surg2021; 46: 552–559.
24.
ZhangDEarpBEBlazarP. Factors associated with 30-day complication, reoperation, readmission, and length of stay after primary total elbow arthroplasty: a database study of 555 patients. Semin Arthroplasty JSES2023; 33: 59–66.
25.
EverhartJSSojkaJHMayersonJL, et al.Perioperative allogeneic red blood-cell transfusion associated with surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am2018; 100: 288–294.
26.
RasouliMRMaltenfortMGErkocakOF, et al.Blood management after total joint arthroplasty in the United States: 19-year trend analysis. Transfusion (Paris)2016; 56: 1112–1120.
27.
HartAKhalilJACarliA, et al.Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am2014; 96: 1945–1951.
28.
OwensJOteroJENoiseuxNO, et al.Risk factors for post-operative blood transfusion following total knee arthroplasty. Iowa Orthop J2020; 40: 69–73.
29.
AnthonyCAWestermannRWGaoY, et al.What are risk factors for 30-day morbidity and transfusion in total shoulder arthroplasty? A review of 1922 cases. Clin Orthop2015; 473: 2099–2105.
30.
GutmanMJStoneMANamdariS, et al.Treatment of elbow periprosthetic joint infection: a systematic review of clinical outcomes. J Shoulder Elbow Surg2020; 29: 411–419.
31.
RudgeWBJEseonuKBrownM, et al.The management of infected elbow arthroplasty by two-stage revision. J Shoulder Elbow Surg2018; 27: 879–886.
32.
KwakJMSoSPJeonIH. Staged revision still works for chronic and deep infection of total elbow arthroplasty?SICOT J2022; 8: 21.
33.
KunutsorSKBeswickADWhitehouseMR, et al.One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review. BMC Musculoskelet Disord2019; 20: 467.
34.
Eyre-BrookAIGandhiMJGopinathP, et al.Revision total elbow arthroplasty: is it safe to perform a single-stage revision for presumed aseptic loosening based on clinical assessment, normal inflammatory markers, and a negative aspiration?J Shoulder Elbow Surg2021; 30: 140–145.
35.
MalkaniALDilworthBOngK, et al.High risk of readmission in octogenarians undergoing primary hip arthroplasty. Clin Orthop2017; 475: 2878–2888.
36.
MooreHGSchnebleCAKahanJB, et al.Unicompartmental knee arthroplasty in octogenarians: a national database analysis including over 700 octogenarians. Arthroplasty Today2022; 15: 55–60.
37.
UrishKLQinYLiBY, et al.Predictors and cost of readmission in total knee arthroplasty. J Arthroplasty2018; 33: 2759–2763.
38.
MurphyWLanePLinB, et al.Readmission rates, causes, and costs following total joint arthroplasty in US medicare population. Orthop Proc2019; 101-B: 142.
