Total Elbow Arthroplasty

Abstract

Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications. Inflammatory arthropathies such as rheumatoid arthritis represent the classic indication for elbow arthroplasty. Indications have been expanded to include posttraumatic osteoarthritis, acute distal humerus fractures, distal humerus nonunions and reconstruction after tumor resection. Elbow arthroplasty is very successful in terms of pain relief, motion and function. However, its complication rate remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures, worse for patients with posttraumatic osteoarthritis. The most common complications of elbow arthroplasty include infection, loosening, wear, triceps weakness and ulnar neuropathy. When revision surgery becomes necessary, bone augmentation techniques provide a reasonable outcome.

The effect of implant design of linked total elbow arthroplasty on stability and stress: a finite element analysis

“…Aseptic loosening is one of the most common causes for revision of TEA (Fevang et al 2009;Skyttä et al 2009;Sanchez-Sotelo 2011). Aseptic loosening of total joint replacements often occurs due to osteolysis at boneimplant interfaces induced by ultra high molecular weight polyethylene (UHMWPE) wear debris (Revell et al 1978;Peters et al 1992;Cadambi et al 1994;Schmalzried et al 1997).…”

Evaluation of results of Total Elbow Arthroplasty with a Linked Semiconstrained Prosthesis

“…Levy et al reported a higher rate of revision for unlinked compared to linked implants. [18] Depending on the rigidity of the fixation of the humeral component to the ulnar component, the implant arthroplasties are designated as constrained, semiconstrained, and unconstrained [19]. In general, the constrained prostheses rarely are used because of their tendency to loosen and break.…”

“…The semiconstrained hinged prostheses have built-in valgus and varus laxity to provide for dissipation of forces. The GSB III, HSS-Osteonics, and the Coonrad-Morrey prostheses are semiconstrained [19].…”

Revision total elbow arthroplasty with the linked Coonrad-Morrey total elbow arthroplasty: a retrospective study of twenty procedures

“…Primary TEA used to be a salvage procedure only for low-demand patients but is increasingly being used for other indications including fractures, osteoarthritis and instability [7,8]. TEA is technically demanding [9] and regardless of design, reports on primary TEA have stated an overall fiveyear failure rate between eight and ten percent and approximately 15 % after ten years [10,11].…”