Outcomes after contact and distance elbow arthrodesis: a retrospective cohort study

BACKGROUND: Elbow arthrodesis (EA) is a rare salvage procedure for non-reconstructible elbow conditions and failed total elbow arthroplasty (TEA). MATERIALS AND METHODS: We retrospectively analyzed 20 adults treated with EA between 2010 and 2024, comparing contact arthrodesis (n = 12) with distance/defect arthrodesis after induced membrane technique (IMT) reconstruction (n = 8). Indications were infection in nine patients, trauma in three patients, osteoarthritis in three patients, non-union in three patients, and inflammatory arthritis in two patients. Outcomes included grip strength, wrist range of motion (ROM), patient-reported outcome measures (PROMS) Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Single Assessment Numeric Evaluation (SANE), complications, and return to work. RESULTS: Primary radiographic fusion was observed in 18 of 20 patients; two patients required revision surgery for nonunion, here secondary fusion was achieved with distance arthrodesis. The mean fixation angle was 102 ± 11°. At a mean follow-up of 4 ± 4 years, no statistically significant differences in PROMS or objective measures were detected between contact and distance arthrodesis. Relative grip strength on the operated side was 0.74 of the contralateral side, and wrist ROM was reduced. In dominant-hand injuries, fixation angle correlated with relative wrist radial-ulnar deviation ROM (r = 0.668, p = 0.009). Peri-implant fractures of the proximal ulna occurred in seven patients and intraoperative bleeding in four. Among patients of working age, 12 of 15 returned to work. CONCLUSIONS: No statistically significant differences in clinical outcomes were detected between defect/distance and contact arthrodesis; however, equivalence cannot be concluded from this underpowered exploratory cohort. Elbow arthrodesis remains a salvage procedure with substantial complication risk. Individualized fusion angle selection, local bone stock, infection status, and patient-specific occupational demands should be considered carefully during preoperative counseling and surgical planning. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.