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The number of revision total elbow arthroplasty (TEA) remains relatively low. As a result, there are relatively few orthopedic surgeons and a limited number of centers with substantial expertise in revising TEA. This study provides a comprehensive description of the current practice concerning revision TEA in a northern European Country based on the data of the Dutch National Implant Registry. Data of all revision TEA procedures performed between 2014 and 2022 were extracted from the national registry, including cases where the primary procedure was either not recorded in the registry or was not a TEA. Descriptive statistics were used to report the current practice of revision TEA in the Netherlands. Five hundred sixteen revision TEAs were performed in the Netherlands between 2014 and 2022. Eighty-four elbows required more than one revision during that period. The primary cause for revision was aseptic loosening 51%. The procedures were performed in 35 centers, and 21/35 centers performed 5 or less revision procedures per year. No center performed 20 or more revision procedures per year. All types of elbow arthroplasty are associated with a considerable rate of complications, and a direct volume-outcome relationship exists in these surgical procedures. Despite the considerable complication rate, the volume of revision TEA remains low, primarily due to the infrequent occurrence of primary procedures. The study reported that aseptic loosening was the primary reason for revision TEA. We recommend centralizing infrequent surgical procedures such as revision TEA in selected highly specialized centers to increase surgeon and center volumes, aiming to yield more favorable outcomes. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to report on the midterm outcomes and complications of revision surgery of total elbow arthroplasty. Methods All patients who had undergone total elbow arthroplasty revision surgery between 2009 and 2014 with semiconstrained total elbow prostheses were prospectively enrolled in the study. Records were reviewed for demographic data; baseline measurements; and several follow-up assessments including the Mayo Elbow Performance Score (MEPS), visual analog scale (VAS) score for pain, Oxford Elbow Score, range of motion, satisfaction, and radiographs. Results A total of 19 revision arthroplasties were included. At a mean follow-up of 57 months, there had been 1 rerevision and 2 removals. One patient was excluded from follow-up because of confounding comorbidity. At last follow-up, MEPS values and VAS pain scores both improved ( P  < .01). The rate of combined good and excellent results on the MEPS was 53%. The mean VAS scores for pain at rest and with activity were 2 and 4, respectively. Fair results for the Oxford Elbow Score were reported, with a mean score of 28 points. Range of motion improved to an average flexion-extension arc of 108° ( P  < .01), and the pronation-supination arc improved to an average of 123° ( P  < .01). All elbows were stable at last follow-up ( P  < .01). Radiographs showed nonprogressive osteolysis around the prosthesis in 3 cases (19%) and suspicion of loosening in 1 (6%). In 11 patients postoperative complications occurred. Of 15 patients, 13 (87%) were satisfied with the result of the revision procedure. Conclusion Revision of total elbow prostheses leads to satisfactory results, less pain, and better elbow function. This procedure is related to a relatively high complication rate. [ABSTRACT FROM AUTHOR]

Near-infrared spectroscopy (NIRS) is more frequently used to monitor regional oxygenation/perfusion of the cerebral and somatorenal vascular bed during congenital heart surgery. However, NIRS probes can be placed elsewhere to assess regional perfusion. We report the intraoperative use of NIRS probes on both calves of an infant to continuously monitor changes in the regional oxygenation/perfusion of a lower extremity whose perfusion was compromised after femoral arterial line placement. The NIRS trend of the compromised limb was compared with the contralateral limb throughout congenital heart surgery including the period on cardiopulmonary bypass (CPB). Our case report illustrates that NIRS technology can be used to monitor ongoing lower extremity vascular compromise during congenital heart surgery when it is not practical to directly access and continuously assess the limb. Transient vascular compromise after invasive femoral arterial line or sheath placement for cardiac catheterization in small infants is not infrequent. NIRS technology in such circumstances may help to decide whether watchful waiting is acceptable or immediate interventions are indicated. Continuous NIRS monitoring showed that limb regional oxygenation remained depressed during CPB but dramatically increased in the post-CPB period. [ABSTRACT FROM AUTHOR]