Total elbow arthroplasty is moving forward: Review on past, present and future

Abstract

The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps have been taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.

Total elbow arthroplasty in haemophilia

“…TEA prosthesis design has evolved considerably since the first elbow replacements were attempted early in the 20th century. Designs that mimic the native joint are quite challenging as stability in the native joint relies on soft tissue structures that may be severely damaged by the disease process that led to joint damage in the first place . Modern designs can be divided into three categories: unconstrained, semi‐constrained and constrained .…”

“…A constrained design, by contrast, involves rigid hinges, which hold the joint together throughout its range of motion. Because significant forces can be transmitted to the prosthesis‐bone interface through this rigid linkage, constrained prostheses are more prone to osteolysis and loosening, as a result, has fallen out of favour in more recent years …”

“…17 Total elbow arthroplasty is much less common than hip and knee replacements, but it has gained popularity in recent years, doubling in use in the United States between 1998 and 2011. 18 TEA has been described as one of the most challenging joint replacements due to the forces at the elbow created by the long lever of the forearm. Furthermore, there is limited bone stock available for the prosthesis.…”

“…Designs that mimic the native joint are quite challenging as stability in the native joint relies on soft tissue structures that may be severely damaged by the disease process that led to joint damage in the first place. 18 Modern designs can be divided into three categories: unconstrained, semi-constrained and constrained. 22 Both constrained and semi-constrained designs represent linked systems.…”

“…Because significant forces can be transmitted to the prosthesis-bone interface through this rigid linkage, constrained prostheses are more prone to osteolysis and loosening, as a result, has fallen out of favour in more recent years. 18,19 A semi-constrained design incorporates a "sloppy-hinge" with an axle and bushing joining the humeral and ulnar portions of the prosthesis. 19 This allows the surrounding soft tissue to provide some support while offering an additional source of stability.…”