Elbow Replacement Arthroplasty Research Articles

Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

Purpose: The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC). Methods: We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications. Results: The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later.Conclusion: Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

Imaging of elbow replacement arthroplasty.

Elbow replacement arthroplasty has become a standard surgical treatment for a variety of diseases of the elbow. First popularized for the treatment of late-stage rheumatoid arthritis and other debilitating forms of joint disease, the current indications have expanded to include primary treatment of elbow trauma. The most commonly used total elbow replacements are linked semiconstrained chromium-molybdenum alloy or titanium alloy prostheses with polyethylene bearing surfaces. These are inserted after resection of the ulnotrochlear joint and typically cemented in place; the radial head is often sacrificed. Modular metal components or massive osteoarticular allografts may be used when there is extensive bone deficiency. Metal radial head replacements are increasing being used for primary fracture treatment and in posttraumatic elbow reconstructive surgery. Long-term outcomes for total elbow replacement are similar to those of other joints, with 10-year survivals of ∼ 90%. Complications specific to elbow implants include infection, aseptic loosening, prosthetic failure, and periprosthetic fracture.

Insufficiency Fracture of Olecranon after Total Elbow Replacement Arthroplasty in Rheumatoid Arthritis: Report of Three Cases

Osteoporosis due to the rheumatoid arthritis and the glucocorticoid therapy predisposes patients to insufficiency fractures. Insufficiency fractures or periprosthetic fractures of the lower extremity in the rheumatoid arthritis have been frequently reported. But those of the upper extremity were rarely reported. We report three cases of the insufficiency fracture of the olecranon after total elbow replacement arthroplasty in patients with the rheumatoid arthritis. All the cases were successfully treated by immobilization for 3 weeks. At the last follow-up, there were no functional impairments or residual symptoms caused by the fractures.

Ipsilateral total shoulder arthroplasty and total elbow replacement arthroplasty: A caveat

Shoulder and elbow replacement arthroplasty both achieve a high degree of success in patients with inflammatory arthritis. When both arthroplasties are performed on the same side, a stress riser can occur in the humeral diaphysis between the tips of the 2 humeral components. When the shoulder arthroplasty is performed first, a short-stemmed humeral component is advised. If a long-stemmed humeral component at either joint is already in place, the cement column for the subsequent arthroplasty should extend to and include the cement column for the extant component.

Total elbow arthroplasty with use of a nonconstrained humeral component inserted without cement in patients who have rheumatoid arthritis.

Most total elbow prostheses that are currently in use require cement for fixation of each component. We developed a new (type-5) prosthesis that does not need cement for fixation. The humeral component is made of cobalt-chromium alloy, and its stem is porous-coated with a plasma spray of titanium alloy. There are two options for the ulnar component: an all-polyethylene type and a metal-backed type with a porous-coated stem. Forty-three elbows in thirty-seven patients who had rheumatoid arthritis were treated with total elbow replacement arthroplasty with use of the type-5 prosthesis. The humeral component was implanted without cement in all elbows, whereas the ulnar component was implanted without cement in eleven elbows and was fixed with cement in the remaining thirty-two. The elbows were followed for an average of three years and ten months (range, two years and six months to five years and six months). The clinical results were assessed according to a modification of the Mayo Clinic Performance Index. At the time of the latest follow-up, the overall result was excellent for six elbows, good for thirty-one, and fair for six. All elbows had been rated as poor before the operation. There was almost complete relief of pain in twenty-nine elbows and mild or occasional pain in the remaining fourteen. Flexion increased markedly, from an average of 104 degrees preoperatively to an average of 133 degrees postoperatively; this difference was highly significant (p < 0.001, Student t test). In contrast, extension (flexion contracture) worsened slightly, from an average of 38 degrees preoperatively to an average of 42 degrees postoperatively; this difference was significant (p < 0.05). There was one postoperative dislocation of the elbow, and ectopic bone formed in another, with recurrence of ankylosis. Both elbows had a reoperation, and a good result eventually was obtained. There were no instances of postoperative infection or neuropathy of the ulnar nerve. Radiographically, there were no radiolucent lines at the bone-metal interface of any of the humeral or ulnar stems that had been implanted without cement, suggesting solid fixation by osseointegration. The results of total elbow arthroplasty with use of this prosthesis appear promising. There was a high rate of relief of pain as well as of restoration of adequate function in patients in whom the elbow was severely affected by rheumatoid arthritis.

Total elbow arthroplasty

Total elbow replacement arthroplasty is a technically demanding procedure that produces good results in those patients who meet the proper selection criteria. It allows improvement in the patient's quality of life by restoring pain-free function to the elbow. The result is greater function of the entire upper extremity by restoring the ability to place the hand where it is needed. This review will discuss the indications and contraindications to replacement arthroplasty. The surgical technique will be discussed highlighting important biomechanical factors that must be considered at the time of joint implantation.

Total elbow replacement arthroplasty for rheumatoid arthritis of the Elbow, long-term 5–20 year followup

Total elbow replacement arthroplasty for rheumatoid arthritis of the Elbow, long-term 5–20 year followup

Total elbow replacement arthroplasty for flail and unstable elbows

Total elbow replacement arthroplasty for flail and unstable elbows