Elbow Prosthesis Research Articles

Origin and characteristics of haematogenous periprosthetic joint infection

ObjectivesRecognition of infectious origin of haematogenous periprosthetic joint infections (PJI) is crucial. We investigated the primary focus and characteristics of haematogenous PJI. MethodsConsecutive patients who presented with haematogenous PJI between 01/2010 and 01/2018 were retrospectively analysed. Haematogenous PJI was defined by diagnosis of infection ≥1 month after surgery, acute manifestation after a pain-free period and positive blood or prosthetic-site culture and/or evidence of distant infectious focus consistent with the pathogen. Fisher's exact, Student's t and Mann–Whitney U tests were used, as appropriate. ResultsA total of 106 episodes of PJI were included, involving 59 knee, 45 hip, one shoulder and one elbow prostheses. The median time from last surgery until haematogenous PJI was 47 months (range, 1–417 months). The pathogen was identified in 105 episodes (99%), including Staphylococcus aureus (n = 43), streptococci (n = 32), enterococci (n = 13), Gram-negative bacteria (n = 9) and coagulase-negative staphylococci (n = 8). Gram-negative bacteria were significantly more often found in hip joints than in knee joints. Blood cultures grew the pathogen in 43 of 70 episodes (61%). The primary infectious focus was identified in 72 episodes (68%) and included infections of intravascular devices or heart valves (22 episodes), skin and soft tissue (16 episodes), the oral cavity (12 episodes), urogenital (12 episodes) or gastrointestinal tract (seven episodes) and other sites (three episodes). ConclusionsIn acute PJI manifesting after a pain-free period, the haematogenous infection route should be considered and the primary infectious focus should be actively searched for. The cardiovascular system, skin and soft tissue, oral cavity, urogenital and gastrointestinal tracts were common origins of haematogenous PJI.

Long-term outcome of custom triflange outrigger ulnar component in revision total elbow arthroplasty

Patients missing the distal humeral condyles are prone to premature bushing wear after total elbow arthroplasty. A midterm study has demonstrated that a custom triflange outrigger ulnar component was successful in preventing this. The aim of this study was to determine whether these results remained stable over time. The outcomes of 6 patients who underwent revision of a loose ulnar component using a custom triflange outrigger component were reviewed in this retrospective case study. The average patient age at the time of revision was 51. The average number of prior operations was 2 (range, 1-3). The mean follow-up was 15 years (range, 10-18 years). At final follow-up, the mean range of extension-flexion was 35° to 135°, and pronation-supination was 65° to 63°. The average Mayo Elbow Performance Score improved to 75 of 100. Four implants were still in place with no radiolucencies or osteolysis. Three patients required revision surgery for broken humeral stems. Two required conversion to another total elbow arthroplasty system after 18 and 14 years for humeral component loosening. These components lasted an average of 4 times longer than the original ulnar components. In our experience, periarticular osteolysis caused by polyethylene wear creates a region of unsupported stem and a stress riser at the junction with the remaining well-supported stem and causes component stem fractures. The concept of an outrigger type of hinge might be useful for active patients requiring an elbow prosthesis in the setting of deficient condyles.

Movement-Based Control for Upper-Limb Prosthetics: Is the Regression Technique the Key to a Robust and Accurate Control?

Due to the limitations of myoelectric control (such as dependence on muscular fatigue and on electrodes shift, difficulty in decoding complex patterns or in dealing with simultaneous movements), there is a renewal of interest in the movement-based control approaches for prosthetics. The latter use residual limb movements rather than muscular activity as command inputs, in order to develop more natural and intuitive control techniques. Among those, several research works rely on the interjoint coordinations that naturally exist in human upper limb movements. These relationships are modeled to control the distal joints (e.g., elbow) based on the motions of proximal ones (e.g., shoulder). The regression techniques, used to model the coordinations, are various [Artificial Neural Networks, Principal Components Analysis (PCA), etc.] and yet, analysis of their performance and impact on the prosthesis control is missing in the literature. Is there one technique really more efficient than the others to model interjoint coordinations? To answer this question, we conducted an experimental campaign to compare the performance of three common regression techniques in the control of the elbow joint on a transhumeral prosthesis. Ten non-disabled subjects performed a reaching task, while wearing an elbow prosthesis which was driven by several interjoint coordination models obtained through different regression techniques. The models of the shoulder-elbow kinematic relationship were built from the recordings of fifteen different non-disabled subjects that performed a similar reaching task with their healthy arm. Among Radial Basis Function Networks (RBFN), Locally Weighted Regression (LWR), and PCA, RBFN was found to be the most robust, based on the analysis of several criteria including the quality of generated movements but also the compensatory strategies exhibited by users. Yet, RBFN does not significantly outperform LWR and PCA. The regression technique seems not to be the most significant factor for improvement of interjoint coordinations-based control. By characterizing the impact of the modeling techniques through closed-loop experiments with human users instead of purely offline simulations, this work could also help in improving movement-based control approaches and in bringing them closer to a real use by patients.

Macroscopic investigation of failed Kudo type 5 total elbow arthroplasty

On the basis of the intra-articular findings during Kudo type 5 elbow prosthesis revision surgery, we infer the mechanisms leading to implant failure. We performed primary Kudo type 5 total elbow arthroplasty on 60 rheumatoid elbows in 45 patients between 1994 and 2003. Revision surgery was performed in 8 patients (9 elbows) because of implant failure. We radiographically assessed their status before this surgical procedure and then assessed the surgical intra-articular findings based on surgery records and photographs. In all cases, revision surgery was necessitated by failure of the ulnar component. There were 2 types of implant failure: fracture of the ulnar component neck (n = 3) and loosening of the ulnar component (n = 6). In the latter group, 2 elbows exhibited valgus deformity of the retrieved ulnar component. There were no cases of metallosis or wear of the articular surface. This study describes the types of implant failure in unlinked Kudo type 5 total elbow arthroplasties with all-polyethylene ulnar components based on the intra-articular findings. Failure of the all-polyethylene ulnar component could have been caused by ulnar neck distortion that occurred prior to polyethylene wear on the joint surface. In addition, valgus stress on the elbow joint may have contributed to these implant failures.

A simple movement based control approach to ease the control of a myoelectric elbow prosthetics in transhumeral amputees

Common myoelectric control strategy remains complex to use and produce unnatural gestures since it does not allow simultaneous movements of several joints. This is especially an issue for the transhumeral amputees who can use an active elbow in addition to active prosthetic wrist and hand. Since most transhumeral amputees have a mobile residual limb, an interesting approach aims at utilizing this mobility to control the elbow. We thus developed a simple electronic device relying on an inertial measurement unit, that can be interfaced with existing commercial myoelectric elbows and which convert chosen displacements of the residual limb into control signals, offering an intuitive way of controlling an active elbow prosthesis whilst allowing a simultaneous myoelectric control of the wrist and hand. We performed an experiment with one transhumeral amputee wearing his myoelectric prosthetic (active elbow, wrist and hand) who was asked to grasp and transfer different objects several times while being recorded with a motion capture system. Theses task were performed twice: with a conventional full myoelectric control and with the proposed movement based control. Several metrics (position error, time, smoothness, along with body compensatory strategies) were used to quantify the performances obtained with these two modes. Analyses showed that the participant was able to perform the tasks in both condition, but that the movement based control approach allowed a reduction in task time and in exhibited body compensatory strategies, by offering an easier access to adjustments of the elbow posture compared to the full myoelectric control approach. This work illustrates the potential of using residual limb mobility in the control of prosthetics, to make it more natural and intuitive, and how this can have an indirect but positive impact on the whole body compensatory strategies exhibited by amputated subjects.

Physiological Loading of the Coonrad/Morrey, Nexel, and Discovery Elbow Systems: Evaluation by Finite Element Analysis.

Wear of polyethylene bearings represents a limiting factor in the long-term success of total elbow prostheses. Bearing stress is 1 factor contributing to accelerated wear. Physiological loading of total elbow prostheses and implant design influence upon bearing stresses have not been well described. This study evaluates bearing stresses in 3 commercially available implant designs under loads associated with daily living. Motion tracking from a healthy volunteer helped establish a musculoskeletal model to simulate flexor and extensor muscle activation at 0°, 45°, and 90° of shoulder abduction with a 2.3-kg weight in hand-forces and moments were measured at the elbow. Resulting physiological joint reaction forces and moments were applied to finite element models of 3 total elbow bearing designs (Coonrad/Morrey, Nexel, and Discovery) to evaluate contact area and polyethylene stresses. Increasing shoulder abduction resulted in minimal changes to the elbow joint reaction force but greater joint moments. All implants showed greater peak stresses with increasing shoulder abduction-elbow varus. Discovery and Nexel achieved greater contact area (23% vs > 100%) and demonstrated up to 39% lower peak polyethylene stresses compared with the Coonrad/Morrey design. Shoulder abduction results in a varus moment at the elbow. Newer bearing designs (Nexel and Discovery) provide a combination of higher contact area, improved load sharing, reduced edge loading, and lower stresses through elbow range of motion when compared with a cylindrical hinge-bearing design (Coonrad/Morrey). Although the Coonrad/Morrey is a clinically successful prosthesis, our physiological loading model shows that Discovery and Nexel provide greater contact area, better load sharing and lower peak stresses. This may lead to a decrease in polyethylene wear rates and the eventual risks of osteolysis and aseptic loosening. Further studies are needed to determine how these findings translate clinically.

Métastase humérale du cancer du rein : prise en charge chirurgicale et revue de la littérature

IntroductionThe humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. The aim of this study is to determinate if prosthetic replacement is an effective and safe solution in treatment of renal cancer. HypothesisProsthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. Material and methodsFifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were reviewed. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. ResultsThe average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. DiscussionSolitary and metachronous bone metastases have a longer survival. Disease-free interval>2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients’ quality of life. Retrospective studyLevel of evidence IV.

“In vitro” Implantation Technique Based on 3D Printed Prosthetic Prototypes

In this paper, Rapid Prototyping ZCorp 310 system, based on high-performance composite powder and on resin-high strength infiltration system and three-dimensional printing as a manufacturing method are used to obtain physical prototypes of orthopaedic implants and prototypes of complex functional prosthetic systems directly from the 3D CAD data. These prototypes are useful for in vitro experimental tests and measurements to optimize and obtain final physical prototypes. Using a new elbow prosthesis model prototype obtained by 3D printing, the surgical technique of implantation is established. Surgical implantation was performed on male corpse elbow joint.

Humeral metastasis of renal cancer: Surgical options and review of literature.

The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. The average age was 63years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. Solitary and metachronous bone metastases have a longer survival. Disease-free interval>2years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life. Level of evidence: IV.

The management of infected elbow arthroplasty by two-stage revision

Deep prosthetic infection is a potentially devastating complication after total elbow arthroplasty, with an incidence of up to 12%. This study examined the demographics, microbiologic profile, and outcomes of infected total elbow arthroplasty treated with 2-stage revision in a tertiary referral unit. We identified 19 consecutive patients (mean age, 65 years) undergoing revision arthroplasty for deep prosthetic infection. All patients underwent a first-stage procedure with removal of implants, débridement, and insertion of an antibiotic-loaded cement spacer, followed by at least 6 weeks of intravenous antibiotics. Fourteen patients required a second-stage revision. Five patients did not undergo a second-stage procedure because of patient choice (n = 2), medical or surgical risk factors (n = 2), and death from an unrelated cause (n = 1). Of the 19 patients undergoing a first-stage procedure, 16 (84%) remained infection free, and 11 of the 14 patients (79%) undergoing reimplantation of an elbow prosthesis remained infection free. Six patients required further surgery (3 for recurrent infection, 3 for noninfective indications). The commonest infecting organism was Staphylococcus aureus (47%). A degree of postoperative ulnar nerve dysfunction occurred in 37% of patients, but all resolved fully without further treatment. Management of prosthetic joint infection using 2-stage revision can result in high rates of eradication, although rates of reoperation and transient ulnar nerve dysfunction are high.

Coonrad-Morrey total elbow arthroplasty for patients with rheumatoid arthritis: 54 prostheses reviewed at 7 years' average follow-up (maximum, 16 years)

Total elbow arthroplasty is a therapeutic option for severe rheumatoid arthritis. We hypothesized that the semiconstrained characteristics of the Coonrad-Morrey prosthesis do not compromise the survival rate of the implant in a rheumatoid elbow. Between 1997 and 2012, there were 54 Coonrad-Morrey total elbow prostheses performed for rheumatoid arthritis in 46 patients. Minimum follow-up was 2 years. There were 35 women and 11 men with a mean age of 60 years (29-83 years). According to the Mayo classification for rheumatoid elbow, there were 30 type IIIA, 21 type IIIB, and 3 type IV. The surgical procedure was the same for all patients. Survivorship was assessed with use of the Kaplan-Meier method, with revision surgery as the end point. The survival rate was 97% (95% confidence interval, 83.6-99.6) at 5 years and 85% (95% confidence interval, 68.3-93.7) at 10 years. At an average of 7 years of follow-up (2-16 years), the mean Mayo Elbow Performance Score was 91 points (55-100 points), and the shortened version of the Disabilities of the Arm, Shoulder, and Hand score was 34 points (0-75 points). There was a significant improvement in Mayo Elbow Performance Score and in all range of motion at latest follow-up in comparison to preoperative values (P < .0001). Radiolucencies were observed in 6 cases around the humeral component and in 6 cases around the ulnar component. Bushing wear was observed in 16 cases (29%). There were 14 complications (26%). Revisions were performed in 6 of them (11%). The Coonrad-Morrey prosthesis provides satisfactory results with follow-up. The rate of complications remains high even if the rate of implant revision stayed low.

Study of functional outcome of total elbow replacement using semi-constrained elbow prosthesis in non inflamatory elbow arthritis

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.

Complication of an Elbow Prosthesis: Screw Breakage of the Ulnar cap and Gout Arthropathy

Complication of an Elbow Prosthesis: Screw Breakage of the Ulnar cap and Gout Arthropathy

Discovery Elbow System: clinical and radiological results after 2- to 10-year follow-up.

Discovery Elbow System (DES) is a semi-constrained prosthesis, mainly used for patients with rheumatoid arthritis (RA). Records from 79 patients with RA (90 DES arthroplasties) were reviewed; 47 patients with 55 DES elbows were re-examined. Range of motion (ROM) of both elbows, upper limb function, and quality of life (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Elbow Performance Score [MEPS], and the RAND 36-Item Health Survey [RAND-36]) were assessed. Cementing quality was assessed, and radiolucent lines measured from plain radiographs. Mean follow-up was 64 (range 24-123) months. Pre-operatively to post-operatively, mean elbow flexion improved from 120° to 146° (p<0.001) and mean extension lag improved from 29° to 24° (p=0.02), respectively. At follow-up, mean supination was 66°, mean pronation was 69°, and mean grip strength was 14kg. Grip strength and ROM (except supination) were similar between the DES elbow and contralateral un-operated elbow. Mean post-operative MEPS was 93 points (excellent, n=38; good, n=14; fair, n=2; and poor, n=1). Mean DASH score was 43 points. The RAND-36 showed that physical functioning, physical role functioning, bodily pain, and general health were lower than the Finnish reference values. Primary cementing was challenging, and radiolucent lines appeared during follow-up. Four prostheses were revised because of aseptic loosening (n=3) and periprosthetic fracture (n=1). DES provides significant improvement in patient's flexion-extension arc. Cementing of the elbow prosthesis was challenging; radiolucent lines appeared during the 5-year follow-up, but their clinical relevance remains unclear. First-generation locking screws may loosen over time. Level IV.

Restoration of Humeral Bone Stock Two Years After Internal Fixation of a Periprosthetic Fracture with a Loose Stem

We describe 2 patients who sustained a periprosthetic humeral fracture with a loosened long-stemmed Coonrad-Morrey total elbow prosthesis. As noted in the literature, the success rate for a major revision with use of strut grafts is around 70%; therefore, both cases were managed without revision of the prosthesis. A submuscular locking plate was placed following typical fracture fixation principles. Screws that interfered with the humeral stem and the distal flange stabilized both the distal fragment and the humeral stem. At 2 years postoperatively, both fractures had healed, with increased endosteal bone stock. In each case, the prosthesis was successfully salvaged, and radiographic reconstitution of the implant-bone interface was noted after 2 years.

The accuracy and precision of radiostereometric analysis in upper limb arthroplasty

Background and purpose — Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb.Patients and methods — PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSAResults — 23 studies were included. Precision values were in the 0.06–0.88 mm and 0.05–10.7° range for the shoulder, the 0.05–0.34 mm and 0.16–0.76° range for the elbow, and the 0.16–1.83 mm and 11–124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included.Interpretation — RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.

Results of Total Elbow Arthroplasty with Cementless Implantation of an Alumina Ceramic Elbow Prosthesis for Patients with Rheumatoid Arthritis.

We investigated the long-term clinical results of total elbow arthroplasty (TEA) by cementless fixation of alumina ceramic unlinked elbow prostheses (J-alumina ceramic elbows: JACE) for the reconstruction of elbow joints with rheumatoid arthritis (RA). Seventeen elbows in 17 patients (aged 44-72 years, average 54.8) replaced by JACE TEA without bone cement were investigated. The average follow-up period was 10.7 (range, 1.0-19.3) years. Clinical conditions of each elbow before and after surgery were assessed according to the Mayo Elbow Performance Index (MEPI). Radiographic loosening was defined as a progressive radiolucent line of more than 1 mm that was completely circumferential around the intramedullary stem. The average MEPI significantly improved from 46.8 points preoperatively to 66.8 points at final follow-up (p=0.0226). However, aseptic loosening was noted in 10 of 17 elbows (58.8%) and revision surgery was required in 7 (41.2%). Most loosening was observed on the humeral side. With radiographic loosening and revision surgery defined as the end points, the likelihoods of prosthesis survival were 41.2% and 51.8%, respectively, up to 15 years by Kaplan-Meier analysis. The clinical results of JACE implantation without bone cement were disappointing, with high revision and loosening rates of the humeral component.

Clinical and radiographic outcome of revision surgery of total elbow prosthesis: midterm results in 19 cases

The aim of this study is to report on the midterm outcomes and complications of revision surgery of total elbow arthroplasty. All patients who had undergone total elbow arthroplasty revision surgery between 2009 and 2014 with semiconstrained total elbow prostheses were prospectively enrolled in the study. Records were reviewed for demographic data; baseline measurements; and several follow-up assessments including the Mayo Elbow Performance Score (MEPS), visual analog scale (VAS) score for pain, Oxford Elbow Score, range of motion, satisfaction, and radiographs. A total of 19 revision arthroplasties were included. At a mean follow-up of 57 months, there had been 1 rerevision and 2 removals. One patient was excluded from follow-up because of confounding comorbidity. At last follow-up, MEPS values and VAS pain scores both improved (P < .01). The rate of combined good and excellent results on the MEPS was 53%. The mean VAS scores for pain at rest and with activity were 2 and 4, respectively. Fair results for the Oxford Elbow Score were reported, with a mean score of 28 points. Range of motion improved to an average flexion-extension arc of 108° (P < .01), and the pronation-supination arc improved to an average of 123° (P < .01). All elbows were stable at last follow-up (P < .01). Radiographs showed nonprogressive osteolysis around the prosthesis in 3 cases (19%) and suspicion of loosening in 1 (6%). In 11 patients postoperative complications occurred. Of 15 patients, 13 (87%) were satisfied with the result of the revision procedure. Revision of total elbow prostheses leads to satisfactory results, less pain, and better elbow function. This procedure is related to a relatively high complication rate.

Postoperative Results of Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis Using the Unlinked J-alumina Ceramic Elbow Prosthesis

Postoperative Results of Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis Using the Unlinked J-alumina Ceramic Elbow Prosthesis

Evaluation of important factors in accepts or reject of upper limb prosthesis in children

&#x0D; &#x0D; &#x0D; Abstract&#x0D; Introduction: upper limb amputee Children usually uses prosthesis for better function. But studies show a high percentage of rejection of the prosthesis in this group. In clinical studies, there are not very different in function of children who use of prosthesis and those who do not. Answer to why children accept and use their prosthesis or reject it could help and improve the future design of the prosthesis and rehabilitation. The aim of this study was finding important criteria for children with below elbow amputation, their parents and therapists for acceptance and use of prosthetics or rejects it in children group. Method: This study was conducted by literature search of Science direct, Google Scholar, Cochran Library, MEDLINE and PubMed between 1966 and 2014 ,that investigated effective factors in accept or reject of below elbow prosthesis in below elbow amputee children.For quality assessment of articles we rated each paper using the Downs and Black score ranges and Pedro scale . The two reviewers independently read and classified the articles by population, type of study and results. Results After initial evaluation and reviews, 14 articles were included in this study. Most studies were reported form and questionnaire and clinical observations.The general characteristics of the prosthesis, prosthesis control method, quality of life, family and the rehabilitation procedures were important factors were explored in these literature. Conclusion According to the studies, it is necessary to optimize the prosthesis according to the real children expectations and needs to improve their quality of life.There are controversial studies about performance and first time prosthesis in children but studies confirmed that Group therapy can increase the acceptance rate of prosthesis. Training and finding ways for function without prosthesis along using it to communicate with the environment, increase motor control and sensory perception that could increase accept of prosthesis in children.&#x0D; &#x0D; &#x0D; &#x0D; Keywords: upper limb prosthesis, children, amputation&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;