The current role of elbow hemiarthroplasty compared to total arthroplasty in the treatment of distal humerus fractures in the elderly. Twice the trouble or half the hassle?

Background: Unreconstructable distal humerus fractures in elderly patients are commonly treated with total elbow arthroplasty (TEA). However, TEA has the major disadvantage of lifelong weight-bearing restrictions. Elbow hemiarthroplasty (EHA) is an alternative that allows full weight-bearing, but it is less commonly performed, and there's a lack of high-quality original research directly comparing it to TEA. Therefore, a systematic review and meta-analysis of all available research were conducted to better understand the differences. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies on EHA or TEA with at least three months of follow-up were included. Primary outcome was the Mayo Elbow Performance Score (MEPS). Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, revision rates, implant-related and general postoperative complications, and range of motion. Results: Thirty-six studies were included, with 502 TEA and 192 EHA patients. MEPS scores were similar (TEA: 87.6; EHA: 85.9; P = .505), but EHA had a significantly better DASH score (19.6 vs. 40.9; P < .001). TEA and EHA had equivalent implant-related (TEA: 11.1, EHA: 7.6%; P = .070) and general postoperative complications (TEA: 9.5%, EHA: 11.6%; P = .145). Revision rates after implant-related complications were also similar (TEA: 6.4%, EHA: 3.3%; P = .051). Conclusion: TEA and EHA demonstrate comparable MEPS outcomes, with EHA achieving better DASH scores. Complication and revision rates remain similar between the two. These findings suggest that EHA is similar to TEA in treating elderly patients with unreconstructable distal humerus fractures, with the added advantage of no weight-bearing restrictions which could explain the difference in DASH scores.