Do Outcomes of Interposition Arthroplasty in Young Patients Differ Based on Indication?: A Systematic Review.

BACKGROUND: Interposition arthroplasty of the elbow is often preferred in young patients compared to implant total elbow arthroplasty (TEA). However, research comparing the outcomes based on diagnosis in patients with post-traumatic osteoarthritis (PTOA) and inflammatory arthritis following interposition arthroplasty is sparse. Therefore, the purpose of this study was to compare outcomes and complication rates following interposition arthroplasty in patients with PTOA and inflammatory arthritis. METHODS: A systematic review was performed using the PRISMA guidelines. PubMed, Embase and Web of Science were queried from inception to December 31, 2021. The search generated 189 total studies, of which 122 were unique. Original studies on interposition arthroplasty of the elbow in the setting of post-traumatic or inflammatory arthritis in patients under the age of 65 were included. Six studies were identified that were suitable for inclusion. RESULTS: The query yielded 110 elbows of which 85 were diagnosed with PTOA and 25 with inflammatory arthritis. The cumulative complication rate following the index procedure was 38.4%. The complication rate in patients with PTOA was 41.2% compared to 11.7% in those with inflammatory arthritis. Furthermore, the cumulative reoperation rate was 23.5%. The reoperation rate in PTOA and inflammatory arthritis patients was 25.0% and 17.6%, respectively. The average preoperative MEPS pain score was 11.0 which improved to 26.3 postoperatively. The mean preoperative and postoperative PTOA pain scores were 4.3 and 30.0, respectively. For the inflammatory arthritis patients, the preoperative pain score was 0 and the postoperative pain score was 45. The overall mean preoperative MEPS functional score was 41.5, improving to 74.0 after the procedure. CONCLUSIONS: This study found that interposition arthroplasty is associated with a 38.4% complication rate and 23.5% reoperation rate in addition to positive improvements in pain and function. In patients younger than 65 years of age, interposition arthroplasty may be considered in patients unwilling to undergo implant arthroplasty.