Unlinked Prosthesis Research Articles

Outcomes of Revision Unlinked Total Elbow Arthroplasty for Rheumatoid Elbow.

Background: Although unlinked total elbow arthroplasty (TEA) is a treatment option for end-stage rheumatoid arthritis (RA) of the elbow, its long-term outcomes were inferior. Moreover, revision TEA could be technically challenging. The unlinked TEA procedure comprises the ease of implant removal at revision and advantage of bone preservation. This study evaluated the clinical outcomes in patients who underwent revision TEA using primary unlinked TEA for rheumatoid elbows. It also aimed to determine whether selecting the unlinked prosthesis for the primary TEA would make revision more accessible and successful. Methods: We retrospectively reviewed data of 13 consecutive patients (14 elbows) who underwent revision TEAs for implant failure due to different aetiologies, excluding septic loosening. Three different unlinked TEA implants were used: the Kudo type-5 with all-polyethylene (AP) ulnar component, Kudo type-5 with metal-backed (MB) ulnar component and K-Now TEA. We evaluated the patients' pre- and postoperative outcomes, including the range of motion, pain score and Mayo Elbow Performance Index (MEPI). Results: Among the 14 elbows, 11 were revised using the Kudo type-5 ulnar component (nine and two with AP and MB ulnar component, respectively), and three using the K-Now. We found that each model of TEA had different tendencies to indication for revision surgery. Three more resulted in further failure. The clinical outcomes were assessed in the 11 surviving elbows. Eight of the 11 elbows showed no pain at the final follow-up. However, the remaining three showed only mild pain. The MEPI revealed that seven cases were excellent, two were good and two were fair. Conclusions: The mode of implant failure was largely dependent on the implant design. Furthermore, partial revision with the same implant design was sufficient in managing implant failure in the early phase. However, conversion from unlinked to linked design could be recommended in patients with progressive failure or instability. Level of Evidence: Level IV (Therapeutic).

Elbow prosthesis after acute fractures : Indications and technique

Good to very good clinical results can be achieved in older patients with the implantation of atotal elbow prosthesis in cases of distal humeral fractures by taking the morphological features of the fractures, the bone quality as well as the individual patient requirements and variables into account. The most commonly used design is the cemented semiconstrained linked total elbow endoprosthesis. The unlinked prosthesis design and hemiarthroplasty require intact or adequately reconstructable musculoligamentous structures or condyles and apreserved or replaced radial head. The recommended weight limit after total elbow prosthesis as well as potential intraoperative and postoperative complications must be considered and discussed with the patients. Asecondary total elbow arthroplasty is also possible after primary conservative treatment approaches, e.g., in the case of contraindicated surgery in the fracture situation, persistent pain and functional restrictions. This article provides an overview of the technique and the appropriate indications.

Revision Total Elbow Arthroplasty with the Semiconstrained Coonrad/Morrey Prosthesis: Follow-up to 21 Years.

Revision total elbow arthroplasty (TEA) has increased, especially in young patients with high functional expectations. The objective of this study was to evaluate the long-term results of revision TEA with a single semiconstrained prosthesis. Thirty-four revision TEAs were performed with a Coonrad/Morrey prosthesis in 32 patients; 2 patients had bilateral procedures. The mean patient age was 61 years (range, 22 to 76 years), and the revision TEA was performed at a mean time of 7.8 years (range, 1.6 to 21 years) after the primary TEA. Etiologies for revisions were humeral and ulnar aseptic loosening (n = 14), ulnar aseptic loosening (n = 8), humeral aseptic loosening (n = 6), septic arthritis (n = 4), and unstable unlinked prostheses (n = 2). Clinical and radiographic evaluations were performed with systematic preoperative infection workup and quantification of bone loss. The mean follow-up was 11.4 years (range, 2 to 21 years). The Mayo Elbow Performance Score (MEPS) at the last follow-up was excellent in 6 cases, good in 18 cases, fair in 8 cases, and poor in 2 cases, with a mean improvement (and standard deviation) between the preoperative values at 42.4 ± 16.1 points and the postoperative values at 81.8 ± 12 points (p < 0.001). The mean pain scores improved significantly from 6.7 ± 1.3 points preoperatively to 1.4 ± 1.4 points postoperatively (p < 0.001). The flexion-extension arc increased significantly (p = 0.02) from 74° ± 27° preoperatively to 100° ± 31° postoperatively. The total number of complications was 29 in 19 revision TEAs (56%). Twenty of the 29 complications simply required monitoring without surgical intervention. Six repeat surgical procedures were required, and 3 implant revisions (9%) were performed. Revision TEA with a semiconstrained prosthesis can provide good clinical results that can be maintained during follow-up. The rate of complications is high. Proper evaluation of the risk-benefit ratio is essential for each revision TEA and should be discussed with the patient. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Total elbow arthroplasty in patients with rheumatoid arthritis.

The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome. A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening. TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967-980.

Total Elbow Arthroplasty: Outcomes Driving the Evolution of Implant Design.

» Since the 1940s, innovations in total elbow arthroplasty (TEA) implant design have been made based on reported outcomes. However, complications still exist and current designs remain imperfect.» Currently, linked (semiconstrained) implants can be used for any indication for TEA; however, aseptic loosening at the bone-cement interface remains a concern.» Unlinked (unconstrained) prostheses have been used primarily in patients with rheumatoid arthritis and in situations where the soft-tissue envelope is intact; however, dislocation and/or instability can occur.» Convertible prostheses may provide a solution when the stability of the elbow can be determined intraoperatively, and a semiconstrained implant can be used if the soft-tissue envelope is not intact. Recent long-term results are promising.» There are 3 questions that we sought to answer in this review: (1) How did the failures of early implants change the evolution of TEA designs? (2) How did the evolution of implant design change the indications for TEA? (3) How do the results after TEA differ depending on the indications?

The History and Future of Unlinked Total Elbow Arthroplasty.

Unlinked total elbow arthroplasty (TEA), which has no mechanical connection between the humeral and ulnar components, has theoretical advantages based on its near-normal elbow kinematics and the preservation of bone stock. Unlinked TEA is appropriate only for patients who have limited bone loss or limited deformity and good ligamentous function. This is because postoperative instability has been a major complication of unlinked prostheses. The concept and goal of unlinked TEA is to share the loading stress on the bone implant interface with the surrounding tissues. Although the loosening rate of unlinked prostheses theoretically should be lower than that of linked prostheses (which have a mechanical connection between the humeral and ulnar components), there is no clear evidence that unlinked TEAs are superior to linked TEAs in this respect. However, we believe that primary TEA should be performed using an unlinked TEA, especially for younger patients, because revision surgery for unlinked TEA results in longer prosthesis survival than revision surgery for linked TEA. Improvement of the design of unlinked prostheses and the introduction of less invasive surgical techniques are required to reduce postoperative instability.

Linked semiconstrained and unlinked total elbow replacement in juvenile idiopathic arthritis: a case comparison series with mean 11.7-year follow-up

Few series report the results of total elbow replacement (TER) in patients with juvenile idiopathic arthritis (JIA). Most report the use of a linked implant. There are theoretical benefits to using an unlinked prosthesis, and thus we report our experience of the clinical benefit and survivorship of both this implant and a linked semiconstrained prosthesis. There were 21 elbows replaced in 14 JIA patients (12 women and 2 men; 14 unlinked, 7 linked). Mean age at surgery was 39.5 years (range, 26-52 years). Mean clinical follow-up was 11.7 years (range, 5.4-17.6 years). Reoperation, including implant revision, was required in 9 elbows (42.9%). Using revision as an end point, survivorship was 95% (95% confidence interval [CI], 74%-99%) at 5 years and 68% (95% CI, 45%-86%) at 10 years. The 10-year survival was 70% (95% CI, 40%-89%) for the unlinked group and 69% (95% CI, 28%-94%) for the linked group. The need for bilateral TER was found to be a risk factor for revision within 10 years of primary surgery (6/11 vs. 0/7 elbows; P = .037). The rate of aseptic loosening seen on radiographs was high in the unlinked group (12/14, 85.7%), but many of these patients continue to function well without need for revision. Both the unlinked Kudo 5 and linked Coonrad-Morrey prostheses for TER can provide benefits in the long-term for most patients with JIA. The need for bilateral TER in this group is associated with higher rate of revision at 10 years.

Total Elbow Arthroplasty

Total elbow arthroplasty (TEA) has been used effectively to treat various conditions about the elbow for more than 40 years. Recent improvements in implant design and the refinement of surgical techniques have decreased the complication rate and made it an attractive treatment option from which satisfactory results can be expected in most cases. The indications for TEA have expanded, but the main goal of the procedure remains pain relief. This treatment option is most appropriate for low-demand patients who necessitate pain relief at the expense of permanent activity restrictions. Careful patient selection, meticulous surgical technique, and appropriate postoperative rehabilitation are critical to successful outcomes. In this article, we discuss the indications for TEA, preoperative planning, and the design features of our preferred implant including linked and unlinked prostheses. Our surgical technique is discussed in addition to postoperative rehabilitation, complications, and expected outcomes.

Biomechanical analysis of total elbow replacement with unlinked iBP prosthesis: An in vitro and finite element analysis

Background Numerous models of elbow prostheses are being used and can be divided into two categories: one being a semi-constrained, linked type; and the other being non-constrained, unlinked type. Recent reports of National Elbow Arthroplasty Registers reveal no significant differences in the survival rates between linked and unlinked prosthesis brands, and the main cause appointed for revision for both types is loosening. Some previous biomechanical studies confirm the presence of abnormal bone stresses for the linked type, which can be associated with the risk of loosening. However for the unlinked type, biomechanical studies are not available that corroborate a loosening risk. It seems, that issue has not yet been fully answered and requires further analysis. Methods Cortex strains adjacent to the elbow joint were measured with strain gauges in synthetic humeri and ulnae, before and after replacement. To assess cancellous bone strains and cement stresses around the implant finite element models validated relative to measured strains were used. Findings Bone strains adjacent to the implant tip increased several times in the humerus and ulna. At the epiphyseal regions a generalised cancellous bone strain reduction was observed for both humerus and ulna relatively to the intact bones. Interpretation The unlinked elbow prostheses can be associated with the risk of bone fatigue failure by overload, particularly in the ulna, and bone resorption by stress-shielding at the epiphyseal regions. The identical structural behaviour relative to linked prostheses associated with the same loosening risks corroborates the results of recent arthroplasty published register reports.

A Pioneering Legacy: The Devas Elbow Replacement 31 Years on

We present a case report of a total elbow replacement that survived 31 years in a young female patient with, early onset rheumatoid arthritis. Professor Michael Devas inserted this self-designed, unlinked elbow prosthesis in 1973. The ulnar component loosened after 17 years and was revised using impaction grafting to restore bone stock. The original prosthesis demonstrated minimal wear and it was therefore reinserted. It functioned for a further 14 years, allowing the patient to continue working virtually pain free as a secretary, mother and housewife. To our knowledge, this is the longest surviving unlinked elbow replacement reported in the literature.

The Evolution of Elbow Arthroplasty: Innovative Solutions to Complex Clinical Problems

Cross, Michael B. MD1; Sherman, Seth L. MD1; Kepler, Christopher K. MD, MBA1; Neviaser, Andrew S. MD1; Weiland, Andrew J. MD1 Author Information

Behandlung der komplexen intraartikulären Fraktur des distalen Humerus mittels Latitude-Ellenbogenprothese

Therapy of comminuted intraarticular distal humerus fractures in elderly patients with primary total elbow arthroplasty to achieve stable and painless function. Use of "third-generation" elbow prosthesis with the following options:--linked total elbow arthroplasty,--unlinked total elbow arthroplasty,--either with or without radial head replacement,--hemiarthroplasty. Comminuted intraarticular distal humerus fractures with poor bone quality, in which stable osteosynthesis is impossible. Failure of internal fixation without the technical possibility of revision osteosynthesis. Posttraumatic osteoarthritis or rheumatoid arthritis. Open fractures (Gustilo-Anderson type II or III) or contaminated wounds should not initially be treated with total elbow arthroplasty. Prosthetic replacement may be considered after consolidation of the soft tissue. Low compliance, high functional demands. Paralysis of the biceps muscle. Supine positioning of the patient. Surgical approach after Bryan-Morrey. Anterior transposition of the ulnar nerve. Preparation of the insertion of the triceps at the distal humerus, capsule and proximal ulna. Reflection of the triceps in continuity with the ulnar periosteum and the forearm fascia. Attempt at reconstruction of the epicondyles to achieve ligamentary stability and to implant an unlinked prosthesis. If this is technically not possible, the prosthesis is linked at the end of the operation. Removal of the distal humerus fragments. Determination of the prosthesis size. Detection of the extension-flexion axis. Opening of the humeral intramedullary canal. Determination of the offset. Preparation of the humeral prosthesis repository. Placement of the trial prosthesis. Potential implantation of a hemiprosthesis, if radial head, proximal ulna and ligaments are unaffected. Otherwise preparation of the ulnar prosthesis repository. If the radial head is unaffected, it can be preserved. Otherwise it has to be resected and preferably replaced. Placement of the ulnar and radial trial prosthesis. After correct trial reposition cementing of all definitive prosthesis components with attachment of a cortical bone graft behind the ventral flange of the humeral component. If there is no sufficient stability at the end of the operation, the prosthesis must be linked by insertion of the ulnar cap. Postoperative anterior upper-arm splint in full extension. Active motion. No active extension for 6 weeks. Avoidance of single-event weight lifting>5 kg, no repetitive weight lifting>1 kg, and no forced elbow movements, e.g., racquet sports. 15 Latitude elbow prostheses were implanted in 2007 and 2008 at the Department of Trauma Surgery of the University Hospital Mainz, Germany, due to the following indications: fractures (n=7), pseudarthrosis (n=4), posttraumatic osteoarthritis (n=3), and rheumatoid arthritis (n=1). Six hemiprostheses, two unlinked and seven linked prostheses were implanted. The mean age of patients was 67 years (31-88 years). For the treatment of acute fractures, the indication was made only in elderly patients. The mean age was 77 years (66-88 years). Eleven of these 15 patients were reexamined after 13.5 months (6-23 months). The mean extension deficit was 15 degrees (0-30 degrees), the mean flexion 119 degrees (95-140 degrees). The mean pronation was 78 degrees (60-90 degrees), the mean supination 79 degrees (50-90 degrees). According to the Mayo Elbow Performance Score, three patients achieved an excellent, seven a good, and one a fair result. The mean Mayo Score was 89.2 (74-100). The mean DASH (Disabilities of the Arm, Shoulder and Hand) Score was 8.4 (0-28).

Effectiveness of revision following linked versus unlinked total elbow arthroplasty

The purpose of this study is to specifically evaluate the implications of unlinked and linked designs on the survivorship of revision surgery. Between 1972 and 1990, 352 linked and 151 unlinked prostheses were inserted at our institution. One-hundred and twenty-two elbows (24%) underwent subsequent revision: 55 linked (16%) and 67 unlinked (44%). Survivorship of the initial and revision total elbow replacement was calculated using a Kaplan-Meier analysis. Comparisons were made between revisions done after a failed primary linked or unlinked designs. The unlinked revised to a linked device was more reliable than when revised to another unlinked device: 1 year survival 84% compared to 47%. Initial survival was 56% at 367 months and 84% at 371 months for the unlinked and linked cohorts, respectively (P < .001). A second revision was required in 12 of the 35 elbows (30%) in the linked cohort and 14 of the 50 elbows (28%) in the unlinked. At our institution, primary linked implants display significantly better long-term survivorship (P < .001) than did the unlinked designs. Unlinked designs are most reliably converted to a linked implant.

Endoprothetische Versorgung des Ellenbogengelenkes

Die häufigste Indikation für den Einsatz einer Ellenbogen-Endoprothese stellt die Gelenkzerstörung im Rahmen einer rheumatoiden Arthritis dar, mit Abstand gefolgt von posttraumatischen Gelenkschäden. Erst in jüngerer Zeit werden auch frische Trümmerfrakturen endoprothetisch versorgt. Heutzutage sind praktisch ausschließlich ungekoppelte sowie gekoppelte Prothesen in sloppy-hinge-Konstruktion im Einsatz. Hinsichtlich Schmerzbefreiung, Beweglichkeit und klinischer Gesamtscores sind die Ergebnisse allgemein sehr gut. Dabei schneiden gekoppelte Implantate besser ab als ungekoppelte. Die Komplikationsrate der Ellenbogenendoprothetik ist nach wie vor hoch. In einer eigenen Serie wurden im Zeitraum von 1987–2005 an 177 Patienten (R.A. 165, PsA. 4, Arthrose 8) 195 Ellenbogenprothesen implantiert (GSB III 116, Coonrad-Morrey 46, Souter-Strathclyde 24, Link-Scharnier 4, Custom-made 4, Pritchard 1). Es fand sich analog zu den Literaturangaben eine hohe Komplikationsrate von 34,4%. An 53 Ellenbögen (27,2%) war eine Gesamtzahl von 89 Revisionen erforderlich. Häufigste und schwerwiegendste Komplikation waren tiefe Infektionen, die in 21 Fällen (10,6%) beobachtet wurden, davon nur ein Drittel als Frühinfekt, die übrigen zwei Drittel im Mittel nach 5,5 Jahren. Die höchste Lockerungsrate wies die Souter-Prothese auf. Trotz guter klinischer Ergebnisse sollte die Indikation zum endoprothetischen Ersatz des Ellenbogengelenkes streng gestellt werden.

Unlinked elbow arthroplasty as primary treatment for fractures of the distal humerus

This study reviews our experience with primary total elbow arthroplasty in the management of acute distal humeral fractures by use of the iBP unlinked elbow prosthesis. We followed up 9 elbows in 9 patients (including 2 with rheumatoid arthritis), with a mean age of 73 years, for a mean of 3.5 years. Functional outcome was assessed with the Mayo Elbow Performance Score and the recently developed Liverpool Elbow Score. Clinical examination and radiologic assessment were performed by an independent surgeon. All elbows were stable at the latest follow-up examination, all patients were able to perform daily activities, and pain relief was satisfactory. The median value for the Mayo Elbow Performance Score was 95 (range, 65-100). This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures. Our results show that this method of treatment provides a reliable and effective way of dealing with these very difficult fractures when internal fixation is not a viable option.

Dislocation after total elbow arthroplasty

Instabilities and dislocations after elbow arthroplasty, in particular in surface or unlinked prostheses, may cause functional impairments occasionally with the need for surgical revision. We provide a review of the literature about the frequency and causes of these complications and present some of our results obtained with the GSB III prosthesis. We examined the trigger mechanisms and frequency of joint instabilities as well as treatment strategies by studying five internationally used types of prostheses on the basis of published results. We evaluated 160 GSB III prostheses regarding the above complications and determined the causes for uncoupling. Unlinked prostheses dislocate in 0-15% of cases, accounting for about 25% of the total complication rate described. All surface prosthesis models, including GSB III, were affected with variable frequency. For 160 GSB III prostheses, the dislocation rate was 7.4%. Frequent causes were errors of rotation of parts of the prostheses and displacements of the centre of rotation. Elbow arthroplasty requires demanding surgery, which is still associated with a comparatively high rate of complications. With correct indication, adequate choice of the type of prosthesis used and sufficient experience gained in surgery techniques, it is possible to considerably lower the rate of disassembling.

Endoprothetik des Fingergrundgelenks

Only a few of the large number of implants developed during the last decades for replacement of the metacarpophalangeal (MCP) joint have proven to be reliable. The rates of loosening and mechanical failure of almost all types of constrained prostheses are so high that their use cannot be recommended at present. For more than 40 years silicone arthroplasty according to Swanson has been regarded as the gold standard in the prosthetic replacement of the MCP joint. In long-term studies this device provided good pain relief and a lasting correction of preoperative ulnar deviation. The degree of patient satisfaction continues to be high after more than 10 years. With the NeuFlex spacer, a modification of the original Swanson implant, a better range of motion and a reduction of wear-related problems is expected. In this study the results of 130 NeuFlex spacers after a mean time of 3.6 years were examined and 82% of the patients were completely pain free. The mobility of the joints improved from 40 degrees preoperatively to 54 degrees after 3.6 years. Radiologically periprosthetic erosions or osteolyses were seen in approximately 15% of implants. A minimal sinking of the stems developed in 24%, a massive one in 6% and 13% of the spacers were broken. Thus the use of the NeuFlex implant resulted in a better range of motion compared to the Swanson spacer, but the problem of radiological appearance remained unchanged. For unlinked prostheses sufficient soft tissue stability is mandatory as well as wear-resistant surface materials. The pyrocarbon prosthesis according to Beckenbaugh is the only implant for which long-term results are available. In a prospective study we evaluated 28 Ascension pyrocarbon prostheses with a mean follow-up of 4 years. Stability was not found to be a problem. Subjective results were satisfactory, the range of motion remained unchanged, however 46% of prosthesis stems exhibited radiolucent seams, 7 prostheses (25%) were rated as loose and 5 of those had to be replaced by a silicone implant. Use of the implant was abandoned, as it was unreliable regarding bony fixation. There are promising concepts in some new prostheses but independent data are still lacking.

Vergleichende Endoprothetik des rheumatischen Ellenbogengelenks

Between 1987 and 2005, 165 patients with rheumatoid arthritis of the elbow, four with psoriatic arthritis, and eight with osteoarthrosis of the elbow were treated with total elbow arthroplasty using 126 semiconstrained GSB III elbow replacement prostheses; 46 semiconstrained Coonrad-Morrey prostheses; 24 Souter-Strathclyde unconstrained, unlinked prosthesis; four constrained link hinge prostheses; two custom-made prostheses; and one Pritchard elbow replacement. All implant procedures relieved pain and improved functionality. The complication rate was 34.4%. Revision surgery was needed in 27.2% of elbows because of infection, dislocation, or aseptic loosening. Survival of the semiconstrained implants with ventral or epicondylar flanges for load transfer was better than that of the other implants. Component linkage with the Coonrad-Morrey implant prevents dislocation without increasing the risk of loosening; therefore, semiconstrained implants are our choice for advanced arthritis of the elbow. Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients.

Kudo type-5 total elbow arthroplasty in mutilating rheumatoid arthritis

We studied 11 patients (14 elbows) with gross rheumatoid deformity of the elbow, treated by total arthroplasty using the Kudo type-5 unlinked prosthesis, and who were evaluated between five and 11 years after operation. Massive bone defects were augmented by autogenous bone grafts. There were no major complications such as infection, subluxation or loosening. In most elbows relief from pain and stability were achieved. The results, according to the Mayo Elbow Performance Score, were excellent in eight, good in five and fair in one. In most elbows there was minimal or no resorption of the grafted bone. There were no radiolucent lines around the stems of the cementless components. This study shows that even highly unstable rheumatoid elbows can be replaced successfully using an unlinked prosthesis, with augmentation by grafting for major defects of bone.

Shoulder and elbow arthroplasty

The Journal of Bone and Joint Surgery. British volumeVol. 88-B, No. 2 Book ReviewsFree AccessShoulder and elbow arthroplasty Edited by G. R. Williams Jr, K. Y. Yamaguchi, M. L. Ramsey and L. M. Galatz Pp. 544. Philadelphia: Lippincott, Williams & Wilkins, 2005. ISBN: 0-78173-853-9. $179.G. KontakisG. KontakisSearch for more papers by this authorPublished Online:1 Feb 2006https://doi.org/10.1302/0301-620X.88B2.0880278bAboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail The editors of this book are known for their special interest in the field of shoulder and elbow surgery. They have ‘recruited’ a cohort of experts to assemble this text, aiming to spread the principles of shoulder and elbow arthroplasty as widely as possible. The contents can be categorised according to each joint. The structure and the organisation of each division is similar; there are three sub-sections: prosthetic implants, surgical technique and disease-specific considerations.The history and development of shoulder arthroplasty is covered in an excellent review of the anatomical, biomechanical and prosthetic considerations essential for an understanding of the subject. The chapter on humeral replacement, written by the two European surgeons who have influenced the philosophy of shoulder prosthetic design, emphasises humeral head osteotomy and introduces the reader to the concept of ‘bony balancing’ as complementary to ‘soft-tissue balancing’ in order to achieve a greater range of post-operative movement. In the 12 chapters on disease specifics, the reader is presented with the special conditions for which a shoulder replacement is indicated. There follows an overview of the major causes of glenohumeral arthritis, highlighting the clinical and radiological findings in each aetiology. The subsequent chapters refer separately to replacement arthroplasty for specific conditions.In the chapter addressing the surgical management of the arthritic shoulder with a deficient rotator cuff, the reader is presented with the information necessary to evaluate the different treatment options, to define the indications for surgical management and to establish a decision -making algorithm. The treatment of patients who develop arthritis of the shoulder after surgery for instability or chronic dislocation, is adequately presented in sequentially separate chapters. Their study offers solutions for the surgeons who manage these difficult cases by digesting the experience from famous clinics and worldwide authorities. Revision arthroplasty of the shoulder is covered thoroughly and some future directions are suggested. The shoulder section is completed with chapters that discuss replacement in tumour cases, touch on their complications and specify post-operative rehabilitation.The modern era of elbow arthroplasty was initiated in the early 1970s, later than that for the shoulder and continues to evolve. The first three chapters of the section on implant selection globally cover the history and the development of total elbow arthroplasty and the anatomy and biomechanics of the arm. Surgical technique is discussed separately, contrasting the linked with the unlinked prostheses. The indications for the use of an implant are described with regard to various pathological conditions, with much detail on both the surgery and the rehabilitation.In the nine chapters in the section on disease-specific considerations, the reader is presented with an overview of the major causes of arthritis of the elbow and a systematic approach to examination of the elbow. The subsequent chapters refer separately to an elbow replacement in differing conditions. In the chapter on replacement arthroplasty for acute fractures, replacement of the isolated radial head, in trauma cases, is curiously omitted.In summary, this volume emphasises the value of experience with regard to shoulder and elbow arthroplasty. The contributions are comprehensive, well illustrated, up-to-date and to the point. It is highly recommended for all orthopaedic surgeons who manage arthritic shoulders and elbows and it will be helpful to all practising orthopaedic surgeons and their residents in training.FiguresReferencesRelatedDetails Vol. 88-B, No. 2 Metrics Downloaded 46 times History Published online 1 February 2006 Published in print 1 February 2006 InformationCopyright © 2006, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download