Total elbow arthroplasty in patients with tumor-like lesions of elbow, preliminary results of a single-center experience

Abstract

Objective The purpose of this study was to investigate the preliminary clinical outcomes of total elbow arthroplasty (TEA) in the treatment of elbow deformity caused by tumor-like lesions. Methods Between September 2009 and June 2017, the technique of triceps facial tongue exposure was adopted for all 11 patients who underwent total elbow arthroplasty. There were 5 females and 6 males with the mean age of 56.7±14.7 years. There were 6patients with synovial chondromatosis and 5 with pathologic hypertrophy of synovium. Seven of 11 patients were performed by posterior approach only, while the other 4by combined posterior-anterior approach. A semi-constrained Coonrad-Morrey prosthesis which provides 7° varus/valgus laxity was used in 7 patients, and custom-made total constrained prosthesis which only allow flexion and extension on a single plane was used in 4 cases. Preoperative average flexion range of elbow was 50.5°±14.0° (range, 20°-70°). The ulnar nerve compression and claw hand deformity was identified in 2patients preoperatively and the nerve was transposed during operation. According to Mayo elbow function score (MEPS score), the average preoperative MEPS score was 42.1±12.7 points (range, 15-60). Results Perioperative complications were not found. None of patients lost in thefollow-up and all the patients were alive. There was no pain in the joints, no triceps fracture or weakening of muscle strength, and no recurrence of the lesions. All 11 patients were followed up for 7 to 63 months with an average of 36.3±19.5 months. The mean MEPS score was improved to 89±7.2 point after surgery (t=-11.993, P= 0.000). The average flextion-extension arc improved from preoperative 50.5° to 105.9° postoperatively (t=-8.697, P=0.000). The average pronation-supination arc improvement from preoperative 105°-123.2° postoperatively (t=-6.901, P=0.000). For the two patients with ulnar nerve deficit before surgery, one patient recovered 6 months after operation, however, the other patient did not 2 years later. One Coonrad-Morrey prosthesis with deep infection was treated by removing the implant. Three of 4 custom-made total constrained prostheses experienced implant failure due to loosening or periprosthetic fracture. The incidence of complications of semi-constrained prosthesis was lower than that of total constrained prosthesis (14% vs. 75%), however, it did not reach a significant difference. Conclusion This study reveals an acceptable outcome with triceps facial tongue exposure for TEA in the treatment of tumor-like lesions of elbow. TEA is a viable good alternative treatment for selected patients with large mass around the elbow or with severe deformation. However, the failure rate of fully constrained prosthesis tends to be higher than semi-constrained one, possible due to its design flaw. Key words: Arthroplasty, replacement, elbow; Paraneoplastic syndromes; Surgical procedures, electiv