Elbow arthroplasty

Abstract

Total elbow arthroplasty (TEA) is an established treatment for arthritic and posttraumatic conditions of the elbow. Restoration of elbow function is possible using either the unconstrained or resurfacing type or the semiconstrained elbow arthroplasty. Surgical approaches that limit triceps detachment, biomechanical analysis of prosthesis position, and improvement in cement techniques have led to improved reliability and longevity in TEA. Ten-year survivorship analysis for constrained and semiconstrained prostheses in two large series of patients who had rheumatoid arthritis have shown similar results, with outcomes comparable with those observed in patients who underwent lower extremity arthroplasty. For patients with primary osteoarthritis, TEA should be considered only when other interventions are unacceptable because of higher complication rates. TEA can be recommended for older patients with acute trauma, extensive comminution, and poor bone quality. Depending on bone and soft-tissue quality, resurfacing and semiconstrained TEA have been used successfully in posttraumatic arthritis. Good results have been reported for revision TEA when no infection is present. Significant bone loss associated with revision procedure may be salvaged with allografting.