Abstract
Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications. Inflammatory arthropathies such as rheumatoid arthritis represent the classic indication for elbow arthroplasty. Indications have been expanded to include posttraumatic osteoarthritis, acute distal humerus fractures, distal humerus nonunions and reconstruction after tumor resection. Elbow arthroplasty is very successful in terms of pain relief, motion and function. However, its complication rate remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures, worse for patients with posttraumatic osteoarthritis. The most common complications of elbow arthroplasty include infection, loosening, wear, triceps weakness and ulnar neuropathy. When revision surgery becomes necessary, bone augmentation techniques provide a reasonable outcome.
Highlights
Total elbow arthroplasty has continued to evolve over time
Elbow arthroplasty is further complicated by the need to violate the extensor mechanism for exposure, the increased risk of infection, the role of the radial head, and potential clinical problems related to the ulnar nerve
Several studies have documented the outcome of elbow arthroplasty in rheumatoid arthritis using both linked and unlinked implants
Summary
There is some confusion regarding the types of implants available to replace the elbow joint. Linked implants were constrained hinges that only allowed flexion and extension. Most linked implants are semiconstrained: their linking mechanism behaves as a sloppy hinge, allowing some rotational and varus-valgus play. The humeral component is porous-coated distally and presents an anterior flange, which increases the rotational stability of the implant and neutralizes the extension forces transmitted to the implant interface. Maintenance of prosthesis congruency depends on the adequate position of each component, ligamentous integrity, and the dynamic stabilizing effect of the musculature. Most of these implants provide a more or less anatomic resurfacing of the distal humerus and proximal ulna; some incorporate a radial head component.
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