Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years

Shirin Modarresi; Joy C MacDermid; David M Walton; Graham J W King

doi:10.1016/j.jhsa.2022.09.010

Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years

J Hand Surg Am. 2022 Dec 22:S0363-5023(22)00545-7. doi: 10.1016/j.jhsa.2022.09.010. Online ahead of print.

Authors

Shirin Modarresi¹, Joy C MacDermid², David M Walton³, Graham J W King⁴

Affiliations

¹ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. Electronic address: smodarre@uwo.ca.
² School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada; Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
³ Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
⁴ Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada.

PMID: 36566104
DOI: 10.1016/j.jhsa.2022.09.010

Abstract

Purpose: Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes.

Methods: The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared.

Results: Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class.

Conclusions: In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries.

Type of study/level of evidence: Prognostic IV.

Keywords: Latent growth curve analysis; postsurgical pain; radial head arthroplasty; recovery trajectories.