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At least 19 recordsLinked to original sources

PubMed2003

[Total elbow arthroplasty. Indications, operative technique and results after implantation of an Acclaim elbow prosthesis].

Total elbow arthroplasty has become a reliable treatment option for patients with rheumatoid arthritis as well as primary or posttraumatic arthrosis. The aim of this study is to present the indications, operative technique and results for the implantation of an Acclaim elbow prosthesis. Case reports are given to demonstrate the indications for prosthesis implantation. Furthermore, the follow-up results are reported for 65 patients after implantation of an Acclaim prosthesis. Pre- and postoperative pain were evaluated using the visual analogue scale. The pain level decreased from 8.0 to 2.3 postoperatively. After implantation of an elbow prosthesis, there was a significant improvement in the range of motion. The mean flexion increased from 103 degrees preoperatively to 140 degrees postoperatively. An increase of 10 degrees was found for both supination and pronation. Complications included temporary ulnary nerve irritation in seven patients, intraoperative fractures in four cases and postoperative elbow dislocation in one case. In conclusion, total elbow arthroplasty results in a reduction of pain and an improvement in elbow movement. However, selection of the right patient is important. Patients are advised not to lift heavy objects or to perform hard physical work. If patients' compliance can not be ensured preoperatively, no total elbow arthroplasty should be performed.

Aged↗

PubMed1986

A review of total elbow arthroplasty and an early assessment of the Liverpool elbow prosthesis.

The elbow joint is frequently affected by rheumatoid arthritis causing pain and disability which limits the use of the upper limb. Excisional or interpositional arthroplasties of the elbow have failed to provide satisfactory results. The design of a total elbow prosthesis in early 1970's followed the principles and evolution of joint replacement in the lower limb. In this study twenty-two Liverpool elbow prostheses (non-constrained) in nineteen patients were reviewed with an average follow-up of 26.5 months. Postoperatively the arc of flexion-extension improved with no change in pronation-supination range. Pain was significantly improved postoperatively. Rheumatoid patients were very pleased, but patients with secondary osteoarthritis were less satisfied. Two prostheses became loose and three had deep infection and were removed. Five patients had postoperative symptoms of ulnar neuritis and in three the symptoms gradually resolved. Early results of total elbow arthroplasty are promising in carefully selected patients.

Adult↗

PubMedDate not supplied

Role of collateral ligaments in the GSB-linked total elbow prosthesis.

The GSB III elbow prosthesis is a loose-hinged type of elbow implant. The introduction of such hinged elbow arthroplasty expanded the indications for elbow replacement to patients with more deficient bone and ligaments. The purpose of this study was to compare the kinematics and stability of the GSB III elbow prosthesis with that of the normal elbow and to investigate the role of the collateral ligaments in the kinematics and the stability of the GSB III total elbow prosthesis in an in vitro model. The results could show a semiconstrained kinematic pattern of the GSB III implant. The mean laxity for varus/valgus stress of the implant without collateral ligament support was significantly greater for all flexion angles when compared with intact elbows (mean, 12.7 degrees versus 5.4 degrees ) and with elbows treated with a standard implantation technique (mean, 9.5 degrees ). The release of the collateral ligaments increased the already observed varus shift after standard implantation of a GSB III elbow prosthesis. The laxity measured without collateral ligaments during loaded movement reached the maximum varus/valgus laxity of the GSB III prosthesis of 12 degrees degrees. The study confirms the role of the collateral ligaments in stabilizing the GSB III elbow prosthesis. Missing collateral ligaments may overload the implant-cement-bone interface and may be one factor contributing to early aseptic loosening of this device.

Aged↗

PubMed2002

Micromotion of the Souter-Strathclyde total elbow prosthesis in patients with rheumatoid arthritis 21 elbows followed for 2 years.

21 elbows in 18 patients with rheumatoid arthritis were treated with a Souter-Strathclyde total elbow prosthesis. 18 elbows were included in a radiostereometry (RSA) study. The aim of this clinical RSA study was to assess the three-dimensional micromotion pattern of the Souter-Strathclyde prosthesis, and thereby gain insight in the aseptic loosening process of this prosthesis. Implants were defined as at risk of aseptic loosening when the translation rate during the second postoperative year was more than 0.4 mm along one or more coordinate axes and/or the rate of rotation was more than 1 degrees about one or more coordinate axes. Clinical examination revealed an increase in the range of motion and a marked reduction in pain. The RSA showed that 8 of 18 humeral components were at risk of aseptic loosening, although no signs of such loosening-defined as a complete radiolucent line of 2 mm or more-were found on the plain radiographs. In 7 humeral components, an anterior tilt about the transverse axis was seen that resulted in an anterior translation of the proximal tip and a posterior translation of the component's trochlea. Long-term studies of the Souter-Strathclyde prosthesis, have shown that this rotation is a specific pattern of failure in some implants. None of the ulnar components was at risk for aseptic loosening. Improvements in fixation of the Souter-Strathclyde total elbow arthroplasty should focus on the humeral component. At present, the lateral flange of the implant is enlarged to improve rotational stability about the transverse and longitudinal axes. The effect of this change in design on micromotion of the Souter-Strathclyde total elbow prosthesis will be studied in a randomized RSA study comparing the new design to the existing one.

Aged↗

PubMedDate not supplied

Outcome of revision surgery for failed primary Souter-Strathclyde total elbow prosthesis.

Total elbow arthroplasty is used for the treatment of the painful, destroyed elbow joint. With the increase in elbow replacement surgery in recent years, the number of revision surgeries will also increase. At our center, 236 primary Souter-Strathclyde total elbow prostheses have been placed. Twenty-four of these have been revised and were followed up for a mean of 74 months (range, 12-165 months). The postoperative clinical outcome after revision surgery can approximate the outcome after primary elbow replacement. Unfortunately, 8 elbows needed to be re-revised, 7 elbow prostheses loosened, and we had 1 early dislocation during follow-up. Three of the eight re-revised elbows had a third revision. Two other patients had a resection arthroplasty because of deep infection after the first revision. After 5 years, 73.8% of the revised elbow prostheses were still in situ. The lack of other satisfactory treatment options, combined with the satisfactory clinical results, justify revision surgery of elbow prostheses. The absence of intraoperative fracture during removal of the relatively small standard components and the availability of long-stemmed revision components, which facilitate fixation in the impaired bone, both support our preference for the Souter-Strathclyde prosthesis.

Adult↗

PubMed2004

Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis.

BACKGROUND: Total elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗

PubMed2004

Influence of previous open synovectomy on the outcome of Souter-Strathclyde total elbow prosthesis.

OBJECTIVES: Open synovectomy of the elbow joint is often performed in early stages of rheumatoid arthritis. Because of poor long-term results after synovectomy, insertion of a total elbow prosthesis is commonly used as a secondary procedure. The aim of this study is to evaluate the influence of previous synovectomy on the outcome after placement of a total elbow prosthesis. METHODS: We inserted 204 primary Souter-Strathclyde total elbow prostheses for rheumatoid arthritis. Two groups could be distinguished: group A with previous synovectomy 3.9 yr (mean) before the elbow replacement (n = 33) and group B without previous synovectomy (n = 171). The mean follow-up was 5.8 yr for group A and 6.3 yr for group B. All patients were assessed clinically and radiologically before the operation, 1 and 2 years later and then at regular intervals. The effect of previous synovectomy was analysed via a Cox model and a generalized linear mixed model for binomial data with multivariate normal random effects. RESULTS: No statistically significant effect of previous synovectomy on pain, function or complaints of the ulnar nerve could be found post-operatively. The post-operative flexion was significantly higher in group B than in group A. The complication-rates were similar for both groups. The overall survival rate for respectively group A and B with revision as endpoint was 66.9% (s.e. 13.4) versus 79.6 (s.e. 4.3) after 10 yr. CONCLUSIONS: Previous synovectomy does not diminish the outcome after total elbow prosthesis in this series and could therefore be considered in early, painful stages of rheumatoid destruction of the elbow joint.

Arthritis, Rheumatoid↗

PubMed2005

Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. Surgical technique.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Kinematics and laxity of the Souter-Strathclyde total elbow prosthesis.

The motion pattern and laxity of 8 cadaveric elbows were recorded with a 3-dimensional electromagnetic tracking device before and after the Souter-Strathclyde total elbow prosthesis was implanted. The Souter-Strathclyde prosthesis replicates the valgus-varus motion pattern of the intact elbow but causes a significant internal rotation of the ulnar shaft of 8.9 degrees +/- 4.1 degrees (P < .0005) at 110 degrees of elbow flexion. One of the reasons for this unphysiological motion pattern is positioning of the humeral component in a mean of 5.4 degrees +/- 6.4 degrees of external rotation compared with the intact elbow (P = .05). This positioning is related to the design of this device. The Souter-Strathclyde elbow prosthesis has a mean maximum valgus-varus laxity of 6.5 degrees +/- 1.5 degrees compared with 4.3 degrees +/- 2.3 degrees for the intact elbow (P = .004). This implant is more constrained than previously tested devices, which may explain its relatively higher loosening rate.

Adult↗

PubMed1989

The Pritchard Mark II elbow prosthesis in rheumatoid arthritis.

Twenty-five consecutive rheumatoid elbows treated with the Pritchard Mark II elbow prosthesis were prospectively followed for 3 (2-5) years. There were marked pain relief and increased motion after the operation. Two elbows were revised, one because of deep infection and the other because of loosening. There were no neuropathies or fractures. The major long-term complication was radiographic loosening (6/24), which mainly occurred in elbows with only moderate rheumatoid destructions.

Adult↗

PubMed2005

Stable fixation of the ulnar component in the Kudo elbow prosthesis. A radiostereometric (RSA) study of 13 prostheses with 2-year follow-up.

BACKGROUND: Concern has been expressed about the large number of radiolucent lines around the ulnar component of the Kudo elbow prosthesis in medium-term follow-up. PATIENTS AND METHODS: We studied the metal-backed cemented ulnar component in 13 Kudo elbow prostheses (type 5) using radiostereometric analysis (RSA). All patients had rheumatoid arthritis. There were 2 men and 9 women with a mean age of 55 years. 2 were operated bilaterally. The metal-backed ulnar component was marked with three 0.8 mm tantalum spheres and the proximal ulna with 5 spheres of 0.8 or 1.0 mm diameter. The initial RSA examination was performed during the first week after the operation. Further examinations were done at 4, 12 and 24 months. Conventional radiographs were taken during the first week postoperatively, and at 12 and 24 months. RESULTS: Translations (medial/lateral, antero/posterior and proximal/distal) were less than 0.5 mm in all but 1 patient who had a maximal translation of 3.4 mm distally. The mean rotations around all three axes were less than 0.4 degrees. The patient who had a translation of 3.4 mm also had varus angulation exceeding 4 degrees. This patient also had progressive circumferential radiolucent lines on conventional radiographs. The Mayo elbow score increased from 40 (25-65) before surgery to 92 (45-100) at 2 years. INTERPRETATION: The fixation of the metal-backed ulnar component of the Kudo elbow prosthesis at 2 years is good.

Adult↗

PubMed1994

Motion and laxity of the capitellocondylar total elbow prosthesis.

The motion and laxity of the capitellocondylar unconstrained total elbow prosthesis were assessed, with use of an electromagnetic tracking device and stimulated muscle-loading, after implantation in seventeen cadaveric elbows. The axis of motion of the elbows with the capitellocondylar implants averaged 2.1 +/- 2.3 degrees more varus angulation than that of the intact elbows. This difference may be attributed to the design of the implant, as the 5-degree-valgus humeral component used in this study has a smaller valgus inclination than the articular surface of the distal aspect of the humerus. Although the maximum valgus-varus laxity of the capitellocondylar elbow prostheses was, on the average, 4.3 +/- 2.4 degrees greater than normal (with simulated muscle-loading), the data must be interpreted in light of the fact that this in vitro study did not allow for soft-tissue healing. The prosthetic components tracked well, and there were no dislocations or malarticulations provided that appropriate soft-tissue tensioning and positioning of the components had been achieved at the time of implantation. Sectioning of either the medial or the lateral collateral ligament resulted in gross instability of the joint after capitellocondylar arthroplasty. The ulnar attachment of the medial collateral ligament was found to be vulnerable to injury during the positioning of the ulnar component of this implant.

Aged↗

PubMed2006

The GSB III elbow prosthesis in rheumatoid arthritis: a 2- to 9-year follow-up.

BACKGROUND: The optimal design of an elbow prosthesis for badly damaged elbows is unkown. We evaluated 23 GSB III semi-constrained (sloppy-hinged) total elbow arthroplasties in 16 consecutive patients with rheumatoid arthritis. PATIENTS AND METHODS: After a mean follow-up period of 5 (2-9) years, we assessed quality of the cementing technique, signs of aseptic loosening, patient satisfaction, range of movement, and determined the Hospital for Special Surgery (HSS) elbow score. 3 patients had died before follow-up; thus, 20 replacements in 16 patients were available for clinical and radiographic study. All patients had endstage rheumatoid arthritis (RA) of the elbow joint. RESULTS: In 2 patients, humeral components were revised due to malorientation. 1 arthroplasty was revised due to aseptic loosening of the humeral component. There were 4 cases of intraoperative fracture which healed uneventfully. The total rate of complications was thus one-third. In 17 of 40 components, the cementing technique was rated as marginal or inadequate. We found no association between cementing technique and loosening. The arc of extension/flexion increased by 19 degrees (0-80), and the range of pronation/supination increased by 31 degrees (0-130). There were no cases of infection or ulnar nerve dysfunction. At the latest follow-up, the HSS elbow score was 84 (40-100) points. 11 of 20 elbows were rated as excellent, 4 elbows were rated as good, 2 elbows were rated as fair, and 3 elbows were rated as poor. 14 of 16 patients were satisfied with the result and the 2 patients who were not satisfied had persistent pain. INTERPRETATION: Despite the inherent problems of cementing in small-calibre medullary cavities, the clinical outcome of the GSB III arthroplasty was encouraging for patients with-end stage RA. The rate of overall complications compared favorably with other studies of semiconstrained elbow arthroplasty for end-stage RA. Most complications of the series were minor and did not necessitate revision.

Adult↗

PubMed1986

Baseball adaptation for below-elbow prosthesis.

A baseball bat adaptation to improve the handling with below-elbow prosthesis is described. The adaptation consists of a ball and socket joint unit interposed between wrist and hand prostheses. A patient who had forearm amputation successfully used the adaptation to play softball.

Artificial Limbs↗

PubMed2002

The Kudo elbow prosthesis in rheumatoid arthritis: a consecutive series of 26 elbow replacements in 24 patients followed prospectively for a mean of 5 years.

The Kudo prosthesis is the most commonly used elbow implant in Sweden. However, there are few reports of the results, besides those reported by Kudo himself. I have implanted 30 Kudo type 4 or 5 elbow prostheses in 28 patients with rheumatoid arthritis. 3 arthroplastics were revised, 2 because of loosening and 1 because of a periprosthetic ulnar fracture. 6 major peroperative or early postoperative complications occurred, but only 1 of these was a failure. 2 patients developed postoperative ulnar neuropathy, one was transient and the other patient died 1 year after surgery. 26 elbows were available for follow-up at an average 5 (2-8) years after implantation. All 26 functioned well although radiographic loosening of the humeral component was found in 1 patient. The average range of flexion increased by 14 degrees while the extension lag was unchanged (35 degrees). Activities of daily living had improved markedly and all but 3 patients were satisfied with their elbow. Radiolucent lines were seen around the proximal part of the ulnar component in 18/26 elbows. Although progressive in 1 patient only, this is a matter of concern, indicating that this component may be the weak part of the Kudo prosthesis.

Activities of Daily Living↗

PubMed1985

Resurfacing elbow prosthesis: shape and sizing of the humeral component.

The sizing and dimensioning of a new unconstrained elbow prosthesis makes use of a geometric axis for humeral articulating surface definition, an axis which is precisely positioned with respect to extra-articular anatomical landmarks. The geometry of the joint was determined by a slicing and digitization technique. It was found that for the humerus an axisymmetric surface is evident and that there exists a centroidal axis which is mostly linear except for a portion at the posterior lateral flange of the trochlea. Sizing studies were carried out on dry bone anatomical specimens and, using a standardized X-ray technique, on the elbows of volunteer subjects. Seven dimensions were chosen for statistical analysis of the joint. A multi-variate normal distribution model, using only the first principal component was found to account for 70% of the variance; components 2 and 3 explained a further 19%. From this analysis, one series of three and five sizes of prosthetic dimensions were established for 95% overall coverage of population.

Biomedical Engineering↗

PubMed1997

[Complete elbow prosthesis for inflammatory and hemophiliac arthropathy. A retrospective analysis of 22 cases].

We retrospectively analysed 22 total elbow prostheses (8 GSB III, 14 Kudo) implanted because of inflammatory (19 elbows) or haemophilic (3 elbows) diseases, in order to evaluate: 1) functional result and mobility; 2) frequency of loosening. The results were evaluated after an average of 36 months [16-67] by an observer who took part neither in therapeutic decisions, nor in surgery. Twenty elbows were associated with severe pain before surgery, while 16 elbows were painless and 5 had occasional pain at follow-up. The range of flexion was 133 degrees (from 96 degrees to 50 degrees) and the average range of extension was 32 degrees (extension ranged from [-10 to -90 degrees]). Only 2 elbows had a range of pronation-supination less than 100 degrees, the average range of pronation was 75 degrees (from [30 degrees to 90 degrees]) and 75 degrees (from [20 degrees to 90 degrees]) in supination. The functional results were comparable for the two types of prostheses. We observed 2 postoperative dislocations (1 GSB III and 1 Kudo) which were stabilized after surgical revision; and one late dislocation (1 GSB III) related to friction-wear. We identified incomplete ossification between the humerus and ulna in the 8 GSB III and 10 of the 14 Kudo. A reduction of 20 degrees in all mobility sectors was identified with the Kudo when ossifications were observed. Two implants became loose : the two pieces of 1 GSB III and the ulnar piece of 1 Kudo. One humeral piece of Kudo was broken at the junction between the stem and the trochlea. Three other GSB III had severe osteolysis which could compromise fixation or subsequent prosthetic revision. For the inflammatory and haemophilic arthropathies, the elbow prosthesis gave painless and satisfactory mobility for the short and medium term. The loosening of the 22 prostheses and the frequency of osteolysis with the GSB III (3/8) justify a longer follow-up.

Adult↗

PubMed1981

A magnetically augmented elbow prosthesis: design and biomechanical evaluation.

Magnetically augmented joint prostheses are a relatively new concept. A prototype of an elbow prosthesis with a magnetically constrained axis was designed by the authors and subjected to various tests. It demonstrated greater stability than nonhinged devices. The magnetic bearing reduces the tensile and rotatory forces on the prosthetic fixation that occur with a constrained hinge device, thus preventing loosening and breakage.

Biomechanical Phenomena↗