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PubMed1975

[St. George's model of total elbow-joint prosthesis].

The elbow-prosthesis, design St. George, a hinge prosthesis is developed according to the principle of the Low Friction Arthroplasty. Only small resection of the joint is necessary so that in the "second line of defence" a resection-arthroplasty of elbow is possible. The experiences on 44 implanted prosthesis and the results of 37 cases are described. Restriction of motion, pain, instability and ankylosis in case of rheumatiod arthritis and posttraumatic arthrosis were the main indications.

Adult↗
PubMed1993

[A newly developed cementless elbow joint prosthesis].

Authors describe briefly the history of the development of elbow arthroplasty. They report on their experiences with the silicone, cementless, unconstrained elbow prosthesis developed by them and implanted in 23 cases during 3 years. The prosthesis is described, the operative indication and the problems of the operative technique are reviewed. On the basis of their results and the low number of complications this method of operation is suggested first of all for the successful treatment of elbows with rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed2005

Kudo total elbow arthroplasty in rheumatoid arthritis. Clinical and radiological results.

We have analysed the results of 28 total elbow replacements in 27 patients. The replacements were made using the Kudo unconstrained, unlinked, total elbow prosthesis. The elbows were all affected by rheumatoid arthritis. The follow-up time was from 3 to 7 years, with a mean follow-up of 58 months. Our results with this prosthesis in rheumatoid arthritis appear promising and only few complications were noticed. In one case, a radiological loosening of the ulnar component was observed at the 5-year visit but without any clinical symptoms and no operations were needed. In two other cases, an open reduction was performed within the first 3 months to correct a subluxation. A triceps tendon was re-inserted for a fourth patient 55 months postoperatively. In general, the range of motion became statistically significantly better with the prosthesis and there was also a high rate of relief of pain in patients in whom the elbow was severely affected by rheumatoid arthritis.

Adult↗
PubMed1990

Functional assessment of control systems for cybernetic elbow prostheses--Part I: Description of the technique.

This paper (Part I of II) presents a novel control scheme with which an amputee commands an elbow prosthesis using myoelectric activity. By mimicking some important characteristics of the intact neuromuscular system, the proposed controller attempts to make the prosthesis respond as the natural elbow to both voluntary commands from the amputee and applied moments from the environment. Also presented is the description of a novel experiment for functionally assessing elbow prosthesis controllers. The experimental design calls for an amputee to perform a constrained motion task while operating a prosthesis capable of implementing a wide variety of controllers. Due to the nature of the constraint, the task emphasizes the prosthesis response to both inputs: voluntary commands and external moments. Application of the experiment to assessment of the proposed control scheme and the control scheme used in a state-of-the-art prosthesis is presented in Part II.

Amputation, Surgical↗
PubMed1999

Long-term results of the GSB III elbow arthroplasty.

Between 1978 and 1986, 59 patients received a GSB III elbow prosthesis, six of them in both elbows. Rheumatoid arthritis (RA) was the underlying cause in 51 of the patients and post-traumatic osteoarthritis (PTOA) in eight. Of these, 24 patients (28 prostheses) have since died; two, both operated on bilaterally, had had their implants for more than ten years and had already been assessed for inclusion in the long-term follow-up. Two patients, each with one elbow prosthesis, have been lost to follow-up and three males who are still living (two with PTOA, one with juvenile RA) had their prosthesis removed before ten years had elapsed. The remaining 32 patients (28 RA, 4 PTOA) with 36 GSB III elbows were examined clinically and radiologically after a mean period of 13.5 years. Pain was considerably reduced in 91.6%. Mobility was increased by 37 degrees in those with RA and by 67 degrees in those with PTOA. There were three cases of aseptic loosening and three of deep infection. The main complication was disassembly of the prosthetic component in nine elbows (13.8%). This last group included two patients with postoperative fractures unrelated to the operative technique and one with neuropathic arthritis. Ulnar neuritis occurred in two patients. Since 87.7% of all the GSB III prostheses implanted in this period remained in situ, our results are comparable with those for hip and knee arthroplasty.

Adult↗
PubMed2006

Coonrad-Morrey total elbow replacement for primary and revision surgery: a 2- to 7.5-year follow-up study.

In this study, 23 patients were treated with the Coonrad-Morrey total elbow prosthesis for posttraumatic arthrosis (15 cases), acute distal humeral fracture (1 case), inflammatory arthritis (3 cases), and revision of another type of total elbow prosthesis (4 cases). After a mean follow-up of 4 years (range, 2-7.5 years) or at revision as a result of loosening or infection, 78% had a satisfactory outcome according to the Mayo Elbow Performance Score. Of the patients, 16 (70%) had no or mild pain and 7 had moderate to severe pain. The loosening rate was 17%. Possible risk factors for loosening were poor cementing and anterior coronoid impingement. Of the patients, 10 (43%) had complications and 7 of these (30%) required revision surgery. The Coonrad-Morrey total elbow prosthesis can lead to successful outcomes for difficult elbow pathologies. However, the complication rate was higher in our series than previously reported. Some technical aspects for use of this implant are outlined.

Adult↗
PubMed1990

Functional assessment of control systems for cybernetic elbow prostheses--Part II: Application of the technique.

This paper (Part II of II) presents application of the technique described in Part I to functional assessment of two myoelectric elbow-prosthesis controllers: the controller implemented in the Boston Elbow, a state-of-the-art elbow prosthesis, and a proposed control scheme that, to a crude degree, mimics control of the intact elbow. Assessment of the controllers was achieved by evaluating an amputee subject's functional capability as he performed a constrained motion task with a prosthesis that implemented each control scheme. Evaluation of the amputee's capability was accomplished off line using sampled values of his myoelectric activity, his limb kinematics, and the interface forces at the constraint. Superior performance was observed with the proposed scheme. Namely, the subject exhibited better synergy among his elbow and shoulder muscles. Furthermore, when using the proposed controller, he exhibited some natural patterns of muscle coordination.

Amputation, Surgical↗
PubMed2002

Importance of a radial head component in Sorbie unlinked total elbow arthroplasty.

The effects of a radial head component on total elbow arthroplasty kinematics and stability were evaluated using an anatomic design unlinked total elbow prosthesis. An electromagnetic tracking device recorded motion and varus and valgus displacements under various conditions in 10 cadaveric elbows. The motion patterns of the intact elbows and the Sorbie-Questor total elbow prostheses with a radial head component were similar, as both tended to have a valgus position in extension, varus at midflexion, and more valgus toward full flexion. Under conditions of simulated muscle loading, the maximum valgus and varus laxity of the elbow prosthesis was, on average, 8.6 degrees +/- 4.0 degrees greater than normal. Without the radial head component, however, significant kinematic disturbances and instabilities were seen. The varus and valgus displacements were 13.3 degrees +/- 5.5 degrees greater than the intact elbows. One total elbow arthroplasty without a radial head dislocated during testing. Increasing the muscle loading across the elbow significantly enhanced dynamic stability of the total elbow arthroplasties, especially in the extension half of elbow motion where instability is greatest. However, this dynamic enhancement of stability was seen only in those elbows in which the radial head component had been implanted. The radial head component is an important stabilizer, particularly in extension for this prosthesis, and possibly for other unlinked total elbow prostheses. Although instability of unlinked prostheses depends on the prosthetic design, the use of a radial head replacement may be an important factor in preventing such instability. Perhaps even more importantly, a radial head component balances the load distribution across the articulation, which could decrease stress on the ulnohumeral articulation and therefore possibly reduce polyethylene wear, osteolysis, and loosening.

Aged↗
PubMed1983

[Measurement study of anatomical shape and size in Japanese elbow joints].

Recently, total elbow replacement has been developed for reconstruction of destructed elbow joints. However, various complications occurred in the constrained or semi-constrained types of elbow replacement, while unconstrained type such as surface replacement showed lower incidence of such complications. On the other hand, development of the elbow prosthesis needs anatomical measurement of the elbow for adaptation to the need of Japanese. Basically, prosthesis should be designed based on the anatomical and biomechanical analysis. In this study, elbow from 36 Japanese cadavers were measured in the outer contour and microradiograms of the sectioned samples. Midline axes of the humerus and ulna, and the center of both medial and lateral epicondyles are fixed as standardized lines for the study in the elbow measurement. The trochlea is situated slightly anteriorly from the midline of the humerus. Width of the trochlea is 21.4 +/- 2.6 mm on the right side and 21.1 +/- 2.8 mm on the left at the anterior margin. At the distal margin, the width is 23.5 +/- 2.8 mm on the right and 23.3 +/- 2.6 mm on the left, and at the posterior margin, 23.9 +/- 3.6 mm on the right and 23.5 +/- 2.8 mm on the left. Saggittal section of the humeral end shows almost complete circle in the articular surface of the trochlea. The diameter is 19.1 mm on the right and 19.3 mm on the left at the longitudinal axis of the humerus, 17.6 mm on the right and 17.7 mm on the left at the central groove, and 24.5 mm on the right, 22.6 mm on the left at the medial margin. Anterior angulation of the trochlea is about 12 degrees. Central line of the trochlea corresponds to the center of the flexion-extension of the elbow, but angulated by 8 degrees from the humeral axis from the anterior view, and internally rotated by 3 degrees from the center of the both epicondyles from the bottom view. In the measurement of the incisura trochlea, opening distance is 18.5 +/- 2.1 mm on the right, 18.5 +/- 2.0 mm on the left, and the depth is 11.8 mm on the right, 11.6 mm on the left at the mean. Forward angulation of the incisura is 30.8 degrees on the right and 28.3 degrees on the left. Width of the olecranon is 25.0 +/- 3.2 mm on the right, 25.0 +/- 2.9 mm on the left and the thickness is 18.6 +/- 1.6 mm on the right, 18.7 +/- 1.8 mm on the left. The central line of the olecranon is supero-laterally angulated about 7 degrees from the longitudinal axis of the ulna. This angulation and lateral opening of the central line of the trochlea seems to produce carring angle of the elbow. Measurement of the elbow size and shape is discussed for designing elbow prosthesis and some biomechanical problems are also represented.

Aged↗
PubMed2002

Present state-of-the-art in elbow arthroplasty.

Prosthetic joint replacement of the elbow is, with some delay in comparison with the shoulder, the finger joints and especially the hip and knee joint, becoming a routine operation at least in more specialised orthopedic and trauma centers. In the seventies and eighties, more than 80% of the indications were in patients affected by rheumatoid arthritis, in which both sides were typically affected, seriously jeopardising their independence in activities of daily living. In the last decade an increasing number of posttraumatic osteoarthritic cases were included in the indications. Among the numerous prosthetic devices, only a few have stood the test of time (> 10 years); a meta-analysis of the world literature shows an average follow-up of less than 5 years. Two main types of prostheses must be distinguished, linked and non-linked. The linked prostheses are, with few exceptions, so-called sloppy hinges with a clearance between both components, permitting movement in the sagittal plane and in the frontal plane and also some rotation. Using the normal anatomical stabilising structures, the stresses on the interface are reduced. This type of linked prostheses has a wider range of possible indications than the non-linked resurfacing prostheses, which require a largely preserved bone stock and intact ligaments in order to avoid instability with subluxations or even dislocations. Resurfacing prostheses can be more or less constrained according to the degree to which they mimic normal elbow anatomy. In order to reduce the stresses on the interface, the more constrained resurfacing prostheses make additional use of an intramedullary stem. The fixation of the device in the bone is achieved with bone cement in nearly all the linked and non-linked prostheses. Sloppy hinges with condylar configurations (as the GSB III elbow prosthesis) or an anterior flange (Coonrad-Morrey) further reduce the stresses on the interface and have better long-term results. Special instruments help to place the prosthesis in correspondence to the normal center of rotation and to minimise the bone resection needed and the risk of intra-operative complications (condyle fractures, shaft perforation). The results concerning pain relief and mobility are, for all properly placed prostheses, very satisfactory in the first years. A reliable account of long-term results (> 10 years of non-interrupted series of elbow prostheses) has so far been given only by a few authors. In cases with rheumatoid arthritis the survival rate at 10 years reaches 90%; the complication rate however is still definitely larger than with hip, knee and shoulder prostheses. This is particularly true for posttraumatic OA cases. Aseptic loosening, infection, instability and ulnar nerve lesions are at the fore and about twice as frequent as in RA, especially in patients below 60 years of age. In order to keep a safe retreat possibility open, we insist on the best possible preservation or reconstruction of normal anatomy (e.g. condyle reconstruction) when implanting an elbow prosthesis.

Arthritis, Rheumatoid↗
PubMed2004

Septic arthritis caused by Chryseobacterium meningosepticum in an elbow joint prosthesis.

Chryseobacterium meningosepticum is a Gram-negative bacillus historically associated with meningitis and sepsis in premature neonates. Clinicians should suspect this organism when Gram-negative bacilli are seen on Gram-stain and culture, particularly in immunocompromised patients, and in cases of disrupted host tissue integrity. We report the first case of septic arthritis due to this organism.

Arthritis, Infectious↗