Technical modifications to elbow interposition arthroplasty

Abstract

Interposition arthroplasty of the elbow involves the interposition of afascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation. Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness. Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability. Once the ulnar nerve has been secured, joint access is established via aposterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using ahorizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed. After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress. The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.