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At least 19 recordsLinked to original sources

PubMedDate not supplied

Kinematics and constraint of total elbow arthroplasty.

Total elbow arthroplasty has been a valuable procedure for patients with rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and failed reconstructive procedures of the elbow. Many of the original designs were simple hinge joints, in which intrinsic complete constraint of the articulation predictably resulted in failure by loosening. Subsequently, the development of elbow prostheses diverged into 2 general types: loose hinge (linked) and resurfacing (unlinked). The main concern with such development is instability, which is attributable to numerous factors including prosthesis design, ligament integrity, and position of the prosthesis. A series of studies have been performed to examine the intrinsic constraint of various total elbow arthroplasty designs, as well as the joint laxity after implantation in cadaveric specimens.

Arthroplasty, Replacement↗

PubMed1994

Infection following total elbow arthroplasty.

Total elbow arthroplasty can be a safe, effective means of relieving the pain and loss of motion owing to arthritis of the elbow; however, infection is a frequent and devastating complication that occurs in 1 of every 20 total elbows. Through careful patient selection, meticulous operative technique, and vigilant postoperative care, this risk can be decreased. If infection does develop, early, aggressive operative management provides the best hope for salvage of the joint.

Elbow Joint↗

PubMed2001

Instability after total elbow arthroplasty.

Resurfacing total elbow arthroplasty is occasionally unstable. Instability may be related to insufficiency of the ligaments or improper tensioning and implant positioning at the time of surgery. Ligament reconstruction has produced mixed results; however, attempts to reconstruct the ligaments are probably worthwhile because conversion of a freshly cemented resurfacing implant to a semiconstrained hinge is very challenging.

Arthroplasty, Replacement↗

PubMed2005

Impaction grafting in revision total elbow arthroplasty.

BACKGROUND: Revision total elbow arthroplasty is often undertaken in patients who have severe osteolysis of both the distal part of the humerus and the proximal part of the ulna. To deal with such bone loss, we have adopted the practice of impaction grafting, which has become a well-established technique in the proximal part of the femur. METHODS: We retrospectively reviewed the results of twelve patients who had undergone revision total elbow arthroplasty with impaction grafting between 1993 and 1997. There were eight women and four men with a mean age of fifty-seven years. All patients were followed for at least two years (range, twenty-five to 113 months), with an average duration of follow-up of seventy-two months. Seven of the patients had an initial diagnosis of rheumatoid arthritis, and five had posttraumatic arthritis. Impaction grafting was undertaken during the initial revision in three of the patients, whereas the remaining nine patients had undergone at least one prior revision without impaction grafting. Four patients had impaction grafting on the ulnar side alone, six had it on the humeral side alone, and two underwent impaction grafting of both the humerus and the ulna. Six allograft struts were placed to span structural defects in five patients. RESULTS: At the time of the latest follow-up, eight of the elbow prostheses were intact after the index impaction grafting procedure. Two elbows had been revised because of loosening, and another had been revised because of a fracture of the ulnar component. A fourth patient had undergone a resection arthroplasty because of infection. The eight remaining patients demonstrated marked radiographic improvement in bone quality in the region of the impaction graft without clinical symptoms of loosening. At the time of the last follow-up, after an additional revision in three elbows, there were five excellent, four good, and three fair results. CONCLUSIONS: Impaction grafting is a reliable technique for treating osteolysis in patients undergoing revision total elbow arthroplasty; however, complications can occur, and a high percentage of patients need additional surgery.

Arthritis, Rheumatoid↗

PubMed2001

Treatment of instability after total elbow arthroplasty.

Instability after total elbow arthroplasty can be due to incorrect component selection or position, inadequacy of the medial or lateral ligaments or triceps tendon, polyethylene wear, limb malalignment, or trauma. Patients with significant loss of bone structure, ligament deficiency, and tendon deficiency around the elbow are at increased risk of instability following total elbow arthroplasty.

Arthroplasty, Replacement↗

PubMed2005

Total elbow arthroplasty after interposition arthroplasty for elbow arthritis.

BACKGROUND: Interposition arthroplasty is an option for the treatment of arthritis of the elbow. Conversion to a total elbow arthroplasty can be considered later, when the patient reaches a suitable age. We investigated the results of conversion of an interpositional elbow arthroplasty to a semiconstrained total elbow arthroplasty in a series of patients. METHODS: The results of twelve consecutive linked semiconstrained total elbow arthroplasties in twelve patients who had had a prior interposition arthroplasty for the treatment of degenerative arthritis of the elbow were evaluated at an average of ten years postoperatively. The average age at the time of the total elbow arthroplasty was fifty years, and the average interval from the interposition arthroplasty to the total elbow arthroplasty was 9.9 years. Pain and elbow performance as measured with the Mayo Elbow Performance Score were assessed in a retrospective chart review and an evaluation of questionnaires, and postoperative radiographs were reviewed. RESULTS: At the time of the latest follow-up, postoperative pain was rated as mild or none in ten of the twelve patients, and the result was rated as subjectively satisfactory in ten patients. The average Mayo Elbow Performance Score improved from 32.1 points (range, 10 to 70 points) preoperatively to 80.4 points (range, 40 to 100 points) postoperatively (p < 0.001). According to these objective criteria, there were three excellent, six good, one fair, and two poor results. All of the elbows were stable following the arthroplasty. Radiographs demonstrated a well-fixed prosthesis in all but one patient who had extensive osteolysis at the site of the humeral component. One other patient had radiographic evidence of bushing wear. Both of these patients required revision procedures. CONCLUSIONS: Semiconstrained total elbow arthroplasty can be performed successfully in patients with a prior interposition arthroplasty. Reliable pain relief and a satisfactory result can be achieved in most patients.

Adult↗

PubMed1990

Results of reconstruction for failed total elbow arthroplasty.

Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory soft-tissue arthroplasty without the use of an interpositional material. When the epicondylar ridges were not retained and there was marked instability, the patients did not achieve satisfactory results.

Adult↗

PubMed1994

[The Guepar total elbow arthroplasty].

The Guepar total elbow replacement is a low friction, minimally constrained gliding prosthesis. The humeral and ulnar components are of metal with intramedullary stems, which are cemented. There is a sigmoid shaped, high density polyethylene interposition bearing. The authors have used the prosthesis in 33 patients with rheumatoid arthritis, 4 with post-traumatic problems, one with chondrocalcinosis and another with degenerative changes of uncertain aetiology. In the patients with rheumatoid arthritis, one sustained a posterior dislocation and two suffered deep infection. In the remaining 30, the overall results were good at an average review of 32 months. The mean range of movement had increased by 31 degrees and pain was absent in 28 elbows. In the management of rheumatoid arthritis total elbow arthroplasty must be part of an overall plan of treatment. Severe involvement of the wrist and shoulder must be dealt with before elbow replacement is considered.

Adult↗

PubMed2004

Allograft-prosthesis composite for revision of catastrophic failure of total elbow arthroplasty.

BACKGROUND: Revision of a failed total elbow arthroplasty is a challenging procedure, often associated with bone deficiency. The purpose of this investigation was to review our experience with a composite allograft-implant reconstruction for patients with a failed total elbow arthroplasty. METHODS: Thirteen patients (thirteen elbows) in whom a total elbow arthroplasty had failed, primarily as a result of loosening of the humeral or ulnar component, were operated on with use of an allograft-prosthesis composite; the composite was placed on the humeral side in four of these patients and on the ulnar side in nine. The delay between the last total elbow arthroplasty and the allograft-prosthesis-composite procedure averaged eight years. RESULTS: At an average of forty-two months after the revision, the Mayo Elbow Performance Score was excellent for four elbows, good for three, fair for one, and poor for five. Nine of the thirteen patients had no or only slight pain in the elbow. The mean arc of flexion was 97 degrees, with an average of 28 degrees (range, 0 degrees to 60 degrees ) of extension to 125 degrees (range, 100 degrees to 140 degrees ) of flexion. There were seven complications affecting seven elbows, and five of the seven required a revision procedure. Deep infection developed in four elbows, and the allograft-prosthesis composite had to be removed from three. Two nonunions occurred at the allograft-humeral junction. CONCLUSIONS: An allograft-prosthesis composite can be a valuable option in selected patients with a failed total elbow arthroplasty with massive bone loss. The union and implant survival rates are high. Deep infection remains the main complication. Hence, we recommend the pursuit of other revision options, such as strut graft reconstruction, whenever possible before resorting to the use of an allograft-prosthesis composite in the surgical treatment of a failed total elbow arthroplasty with massive bone loss.

Adult↗

PubMed2006

Revision total elbow arthroplasty for prosthetic fractures.

BACKGROUND: Fractures of total elbow arthroplasty components are uncommon, and the literature provides little guidance regarding the management and outcomes of treatment of these complications. The goal of this report was to investigate the prevalence and management of fractures of ulnar and humeral components following total elbow arthroplasty and to review our experience with cement-within-cement reconstruction for revision following such fractures. METHODS: Between 1979 and 2003, twenty-four patients with a total of twenty-seven fractured total elbow arthroplasty components (seventeen ulnar and ten humeral) of different designs presented to our institution. Twenty-six implants underwent subsequent revision elbow arthroplasty at our institution. Fourteen of those revisions were done with a cement-within-cement technique, and twelve, with traditional methods. Twenty-one patients (twenty-three implants) were available for final follow-up, and data that had been acquired prospectively and entered into the institutional arthroplasty database were reviewed retrospectively. At the time of final follow-up, the Mayo Elbow Performance Score (MEPS) was calculated and preoperative, postoperative, and most recent radiographs were examined for bone loss, bushing wear, and integrity of the bone-cement interface. RESULTS: The prevalences of humeral and ulnar component fracture following primary total elbow arthroplasties performed at our institution were 0.65% and 1.2%, respectively. At a mean of 5.1 years following revisions for those fractures, the MEPS was excellent for eight patients, good for five, fair for six, and poor for two. The average MEPS was 82 points following the revision total elbow arthroplasties done with the cement-within-cement technique and 78 points following the revisions done with the traditional method of cement removal and insertion of a revision component. Complications included seven intraoperative cortical perforations; five nerve injuries, two of which were permanent; three triceps avulsions; and one deep infection. CONCLUSIONS: Implant fractures following total elbow arthroplasty are uncommon. They occur for several reasons, such as notch sensitivity, component design, and high stresses due to bone deficiency. Revision techniques, such as cement-within-cement reimplantation, are reliable for relieving pain and restoring function; however, the rate and spectrum of complications are a cause for concern. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adult↗

PubMedDate not supplied

Total elbow arthroplasty with massive composite allografts.

Total elbow arthroplasty is challenging when there is extensive bone loss. We studied retrospectively the long-term (mean, 6.5 years) clinical and radiographic results of 10 patients in whom 14 massive allograft-prosthetic composites were used in such clinical situations. The mean arc of active flexion/extension was 92 degrees. The Bryan-Morrey and Hospital for Special Surgery elbow scoring systems were used and revealed a modest improvement in pain and stability but a disappointing return of function, with independent self-care possible in only 3 patients, household and employment activities in 2, and recreational pursuits in 2. Three patients claimed that they were unable to use the elbow. Multiple procedures (mean, 2.2) were sometimes required to optimize the result. The 79% rate of allograft-host union is similar to that of hip and knee arthroplasty. The use of massive allografts is a reasonable alternative in salvage situations involving total elbow arthroplasty with massive bone loss.

Aged↗

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↗

PubMed1990

The osteo-anconeus flap. An approach for total elbow arthroplasty.

Twenty-seven consecutive primary total elbow arthroplasties were done with a technique that preserved the continuity of the attachment of the triceps brachii muscle with a wafer of bone from the reflected extra-articular portion of the olecranon and with the lateral fascia of muscles of the forearm. During closure, the wafer was reattached to the broad cancellous surface of the olecranon with sutures through the bone. The elbows were immobilized for an average of sixteen days postoperatively. The patients who were available for follow-up were re-examined at an average of 3.9 years, and the strength of the triceps muscle was checked. No extensor lag or avulsion of the triceps occurred, and mild extensor weakness was seen in only two elbows. No patient had early or late drainage of the wound or infection. The average range of motion compared favorably with that in other reported series. This osteo-anconeus posterior approach is advocated for total elbow arthroplasty because it provides rapid and wide exposure, it is associated with a low rate of complications related to the wound, and it preserves the strength of the triceps.

Elbow Joint↗

PubMed1990

Total elbow arthroplasty.

The results of 36 total elbow arthroplasties in 32 patients are presented. The follow-up period ranged from 3 to 12 years. The preoperative diagnosis was rheumatoid arthritis in 27 patients and posttraumatic degenerative joint disease in 5. There were 23 women and 9 men. Unconstrained prostheses (London) were implanted in 6 elbows, semiconstrained prostheses (MAYO, AMC, and triaxial) in 26, and constrained prostheses (GSB, Schlein) were used in 4. There were five perioperative fractures (14%) that were successfully treated nonoperatively. Three ulnar nerve neuropraxias occurred (8%), one of which required surgical exploration and repeat anterior transfer of the nerve. Two superficial postoperative infections (6%) responded to nonoperative treatment. Major complications necessitating revision surgery occurred in 18 (50%). Loosening of the prostheses occurred in nine (25%); two were treated by reimplantation, with prosthetic removal in the others. Deep infections in four (11%) and dislocations occurring in two (6%) necessitated prosthetic removal. Traumatic fractures occurred in two (6%); one was successfully treated by internal fixation, while the other failed internal fixation, requiring prosthetic removal. Radiolucent lines were seen in 20 (56%).

Adult↗

PubMed1982

Revision surgery following a failed total elbow arthroplasty.

The need for revision surgery following total elbow arthroplasty can be minimized if certain principles are observed. These include careful preoperative assessment for diaphyseal bone size, the presence of anatomic resources for arthroplasty, the possible need for future adjacent joint arthroplasties, meticulous surgical detail during the arthroplasty, and prompt diagnosis and correction of postoperative problems. Many of the problems following total elbow arthroplasty can be surgically corrected by replacing the high-density polyethylene bearing. Other problems are amenable to arthrodesis of the joint. Although the complication rate and need for revision surgery have diminished with improved implant design and improved surgical technology, it is helpful both to the patient and to the surgeon to discuss the potential problems and the risk versus gain ratio with the patient so that a clear understanding of the reconstruction is understood by everyone.

Elbow Joint↗

PubMed2005

Triceps insufficiency following total elbow arthroplasty.

BACKGROUND: Over the past decade, the indications for total elbow arthroplasty have increased. One complication that is well recognized but is poorly described in the literature is insufficiency of the extensor mechanism involving complete or partial rupture, or avulsion, of the triceps tendon. We therefore reviewed the records of patients who had undergone surgery for the treatment of triceps insufficiency following total elbow arthroplasty to determine the management options and outcomes of intervention for this problem. METHODS: The records on 887 total elbow arthroplasties performed between 1982 and 2001 were assessed to identify patients who had undergone a subsequent procedure on the triceps. Patients in whom triceps insufficiency developed after débridement for infection were excluded, leaving sixteen elbows in fourteen patients. A Mayo Elbow Performance Score was calculated and elbow extension strength against gravity was measured at the time of final follow-up. RESULTS: There were seven male and seven female patients. The mean age was fifty-four years. The mean duration of follow-up after the triceps reconstruction was sixty-seven months. Three basic techniques were used to repair or reconstruct the extensor mechanism; these included direct suture in seven elbows, anconeus rotation in four, and use of an Achilles tendon allograft in four. The capacity to extend against gravity was restored to fifteen of the sixteen elbows. According to the Mayo Elbow Performance Score, eleven elbows had an excellent outcome, three had a good outcome, and two were considered a clinical failure. CONCLUSIONS: In most patients with triceps insufficiency following total elbow arthroplasty, it is possible to reconstruct the triceps mechanism with a procedure appropriately selected on the basis of tissue quality, tendon retraction, and the status of the olecranon.

Achilles Tendon↗

PubMed2003

[GUEPAR I total elbow arthroplasty in rheumatoid arthritis: 19 implants followed an average of 67 months].

INTRODUCTION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant used since 1985. Only one multicenter study has reported the mid-term results of this implant in rheumatoid arthritis. We presented a monocentric retrospective study evaluating the results of 19 GUEPAR I total elbow arthroplasty in rheumatoid arthritis with a mean follow-up of 67 months. MATERIALS AND METHODS: Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started. RESULTS: At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty. DISCUSSION-CONCLUSION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion.

Adolescent↗

PubMedDate not supplied

Salvage of failed total elbow arthroplasty.

We had to revise 14 total elbow arthroplasties, three for infection, six for aseptic loosening, four for instability, and one for a failed bearing mechanism. All of the infected elbows were converted to resection arthroplasty with elimination of infection but with poor function; in one acceptable motion was achieved after a fascial arthroplasty. Those that failed aseptically were salvaged with reimplantation of other devices, either a custom implant or a semiconstrained device, which was also used in those nonconstrained elbows that failed because of dislocation. All of the noninfected elbows were successfully revised with relief of pain and motion comparable to or better than that present before revision.

Elbow Joint↗