JSES International - 2026-05-01 - Journal Article
Functional outcomes and complications of distal humerus hemiarthroplasty performed in acute versus salvage cases: a systematic meta-analysis.
Gosselin C, Hao KA, Bonnevialle N, Mansat P, Barret H
Topics
Key Takeaway
Distal humerus hemiarthroplasty yields comparable MEPS (86 acute vs. 83 salvage) and DASH scores (16.7 vs. 17.3) with no significant difference in complication rates (26.5% vs. 19.3%) between acute and salvage settings.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic meta-analysis compared functional outcomes and complications of DHH performed acutely for comminuted distal humerus fractures versus as salvage after failed ORIF. Eighteen studies with 583 patients were pooled using random-effects meta-analysis, analyzing MEPS, DASH, ROM, complication, reoperation, and revision rates. No statistically significant differences were found between groups in any outcome measure, though the salvage cohort was markedly underpowered at only 36 patients.
Key Limitation
The salvage cohort comprises only 36 patients across 18 studies, rendering the equivalence comparison statistically underpowered and susceptible to type II error.
Original Abstract
BACKGROUND
Distal humeral hemiarthroplasty (DHH) is a treatment option for comminuted joint fractures of the elbow, particularly when osteosynthesis is not possible or has failed. This meta-analysis aims to compare the clinical and functional outcomes of DHH performed for distal humerus fractures acutely versus as salvage after failure of osteosynthesis (open reduction and internal fixation [ORIF]).
METHODS
A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies reporting cases of DHH for complex distal humerus fractures were included and grouped according to the surgical context: acute (initial fracture) or salvage (ORIF failure). The variables analyzed included functional scores (Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand), joint range of motion (flexion, extension, pronation-supination), complication rates, reoperation rates, and revision rates. Comparisons were performed using random-effects meta-analysis.
RESULTS
Eighteen studies totaling 583 patients (547 acute; 36 salvage) met inclusion. Functional scores were comparable between groups (Mayo Elbow Performance Score, 86 vs. 83; Disabilities of the Arm, Shoulder and Hand, 16.7 vs. 17.3). Pooled complication rates were 26.5% in acute cases and 19.3% in salvage cases; between-group differences were not statistically significant in our meta-analytic comparison.
CONCLUSION
DHH offers comparable functional outcomes and similar complication rates whether performed acutely or as salvage after failed ORIF. Prospective and adequately powered comparative studies are needed to refine indications and quantify risks.