Elbow Arthroplasty Using a Convertible Implant

Abstract

Total elbow arthroplasty remains the most definitive functional procedure for patients with end-stage painful arthritis of the elbow. Complication rates have historically been quite high, and early revision was not uncommon. A greater understanding of elbow anatomy and kinematics has led to advances in prosthetic design and surgical technique. The success of modern elbow arthroplasty for low-demand patients with rheumatoid arthritis has approached that of hip and knee arthroplasty. Mechanical failures have been noted to increase as a complication of both longevity and the use of elbow arthroplasty in a younger, higher-demand patient population. As the indications for total elbow arthroplasty widen to include more complex situations, it becomes more important to precisely recreate the flexion-extension axis of the elbow to optimally balance muscle forces and ligaments in an effort to improve implant durability. Advances in implant modularity and instrumentation can make determination and recreation of the flexion-extension axis more reliable and reproducible. An anatomic convertible implant allows the surgeon great versatility in choosing to perform hemiarthroplasty or unlinked or linked total elbow arthroplasty with assurance that later revision can be performed without the compulsory removal of well-fixed components. Conversion from an unlinked to a linked constraint, and visa versa, can be performed at any time. If late conversion is required, it can be performed in a minimally invasive fashion.

Role of an Anterior Flange on Cortical Strains Through the Distal Humerus After Total Elbow Arthroplasty With a Latitude Implant

“…Several designs of total elbow arthroplasties are currently commercially available. [1][2][3][4][5][6][7] Some of these designs incorporate an anterior flange on the distal aspect of the humeral stem. 5,8,9 When a flange component is used, surgeons have the option of placing a wedge of bone or bone cement between the anterior surface of the humerus and the flange.…”

Elbow hemiarthroplasty for acute reconstruction of intraarticular distal humerus fractures: A preliminary report involving 4 patients

“…Hemiarthroplasty for fracture treatment was briefly mentioned by Gramstad et al (2005), but no results were reported. Here we report our preliminary experiences of HA in 4 patients using the Kudo humeral component (Biomet Inc., Warsaw, IN, USA).…”

Linked semi-constrained total elbow prosthesis in chronic arthritis: results of 18 cases

“…More recently, the new generation of total elbow arthroplasties, as the Latitude (Tornier), introduced the concepts of prosthetic modularity and convertibility that provides the surgeon with the option to change between a linked or semi-linked prosthesis during the same procedure. Also, this new prosthesis with three different types of offsets can be configured as a humeral hemi-arthroplasty and with the axis bolt of the humeral component cannulated to facilitate the reattachment of the collateral ligaments to the implant or the bone [41].…”