Total Elbow Arthroplasty After Interposition Arthroplasty for Elbow Arthritis (original) (raw)
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A retrospective review of a series of interposition arthroplasties of the elbow
Shoulder & Elbow, 2014
Background Interposition arthroplasty (IA) is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. The outcome and complications of an IA were evaluated. Methods We retrospectively reviewed 18 consecutive cases of interposition arthroplasty (IA) (one case was excluded as a result of incomplete records). Pre-and postoperative pain and function were evaluated. Complications, re-operations and revisions were recorded. Results The mean age was 41 years (range 19 years to 59 years) at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 12 cases and inflammatory arthritis in five cases. The median follow-up was 54 months (range 8 months to 120 months). In 15 cases, at least one re-operation was performed. Seven cases were revised, with four of these to a total elbow replacement, an arthrodesis was performed in two cases and a redo interposition was carried out in one case. The median interval from the interposition to revision was 23 months (range 8 months to 88 months). In 10 patients with the interposition currently in situ, mean visual analogue scale score for pain improved from 7.4 to 2.4 and mean Mayo Elbow Performance Score improved from 42 to 76 points. Conclusions IA offered an improvement in pain and function but at a high cost. It is associated with a high complication rate the need for revision surgery.
Primary total elbow arthroplasty
Indian Journal of Orthopaedics, 2013
Background: Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced. Conclusion: Elbow arthroplasty remains a valuable option for deformed and ankylosed elbows especially in the demanding patients with crippling deformity of the elbow.
Journal of Arthroplasty, 1990
The results of 36 total elbow arthroplasties in 32 patients are presented. The follow-up period ranged from 3 to 12 years. The preoperative diagnosis was rheumatoid arthritis in 27 patients and posttraumatic degenerative joint disease in 5. There were 23 women and 9 men. Unconstrained prostheses (London) were implanted in 6 elbows, semiconstrained prostheses (MAYO, AMC, and triaxial) in 26, and constrained prostheses (GSB, Schlein) were used in 4. There were five perioperative fractures (14%) that were successfully treated nonoperatively. Three ulnar nerve neuropraxias occurred (8%), one of which required surgical exploration and repeat anterior transfer of the nerve. Two superficial postoperative infections (6%) responded to nonoperative treatment. Major complications necessitating revision surgery occurred in 18 (50%). Loosening of the prostheses occurred in nine (25%); two were treated by reimplantation, with prosthetic removal in the others. Deep infections in four (11%) and dislocations occurring in two (6%) necessitated prosthetic removal. Traumatic fractures occurred in two (6%); one was successfully treated by internal fixation, while the other failed internal fixation, requiring prosthetic removal. Radiolucent lines were seen in 20 (56%).
Results of Total Elbow Arthroplasty in Patients Less Than 50 Years Old
The Journal of hand surgery, 2017
Total elbow arthroplasty (TEA) is a treatment option for end-stage arthritis in low-demand patients willing to accept the limitations of TEA. Concern remains regarding the longevity of TEA implants, especially in younger patients. The purpose of this study was to determine the failure rate and complication profile of TEA performed in patients aged less than 50 years. Between 2009 and 2013, 11 linked TEAs were performed in patients aged less than 50 years (mean age, 37 years; range, 22-47 years). Outcome measures included pain; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; Mayo Elbow Performance scores; complications; and reoperations. Elbows were observed for a minimum of 2 years or until mechanical failure. Mean follow-up was 3.2 years. At follow-up, 82% of TEAs had experienced a complication. Six elbows sustained mechanical failures (5 had ulnar loosening and one had humeral loosening). Pain improved from 8.0 to 4.9. Extension improved from 34° to 22° and fl...
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2015
Total elbow arthroplasty (TEA) is increasingly used for the treatment of advanced elbow conditions to reduce pain and improve function. However, TEA is still associated with a higher complication rate than total hip and knee arthroplasty despite advances in the design and surgical techniques. This prospective clinical study reports the outcome of the Discovery Elbow System (Biomet, Warsaw IN, USA), which has been in clinical use in the United Kingdom since 2003. The study included a total of 100 Discovery Elbows (April 2003 to January 2010) with a minimum 2-year follow-up, including 75 primary and 25 revisions (60% women and 40% men; mean age, 62 years). Outcome was assessed by means of the Liverpool Elbow Score, pain experience, patient satisfaction, range of motion, and radiographic imaging. The mean follow-up period was 48.5 months (range, 24-108 months). The Liverpool Elbow Score improved from 3.79 to 6.36 (P < .001). The percentage of pain-free patients was substantially inc...
Total elbow arthroplasty is moving forward: Review on past, present and future
World journal of orthopedics, 2016
The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps have been taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.
Kinematics and constraint of total elbow arthroplasty
Journal of Shoulder and Elbow Surgery, 2005
Total elbow arthroplasty has been a valuable procedure for patients with rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and failed reconstructive procedures of the elbow. Many of the original designs were simple hinge joints, in which intrinsic complete constraint of the articulation predictably resulted in failure by loosening. Subsequently, the development of elbow prostheses diverged into 2 general types: loose hinge (linked) and resurfacing (unlinked). The main concern with such development is instability, which is attributable to numerous factors including prosthesis design, ligament integrity, and position of the prosthesis. A series of studies have been performed to examine the intrinsic constraint of various total elbow arthroplasty designs, as well as the joint laxity after implantation in cadaveric specimens.
International Journal of Orthopaedics Sciences, 2018
Background: Total Elbow Replacement is considered when there is disabling arthritis of the elbow. Various eteologies are responsible for this arthritis, commonest being Rheumatoid Arthritis. Other causes include, post traumatic arthritis, tumor affection of elbow, rarely haemophilic arthritis. Indications also include distal humerus fractures/ nonunion in select elderly patients. Materials and Methods: 7 patients of Elbow arthritis were operated for Total Elbow Arthroplasty at our institute between, 2013-2015. There were 4 males and 3 females in our study. Baksi sloppy hinge prosthesis was implanted in all our patients. Results: Evaluation of patients was done at 6, 12, 18 months and final evaluation was done at 24 months in all our patients. Significant improvement in functional score, stability and range of movement was documented. Total Elbow Replacement is not a routinely performed surgery as such and has a steep learning curve which is a technical challenge. No major complication was noted in our study. Conclusion: Total Elbow Replacement provides stable, painfree elbow with functional range of movement and negligible complications if performed with technical expertise.
Interposition arthroplasty of the elbow with hinged external fixation for post-traumatic arthritis
Journal of Shoulder and Elbow Surgery, 2008
This retrospective case series reviewed 9 men and 4 women (mean age, 41 years) with severe post-traumatic elbow arthrosis treated with interposition arthroplasty and temporary hinged external fixation. In 2 patients, treatment was considered to have failed because of early postoperative instability, and their results were classified as poor. The remaining 11 were followed up for a mean of 4 years (range, 1-11 years). The mean arc of flexion improved from 48 before surgery to 110 after surgery. The mean postoperative Broberg-Morrey score was 77 points, reflecting a mean improvement of 41 points (range, 13-68 points) and corresponding with 1 excellent, 4 good, 4 fair, and 4 poor results. Four patients had severe instability associated with bone loss of the distal humerus or trochlear notch. Interposition arthroplasty can improve elbow motion and function but at the expense of elbow stability despite hinged external fixation.