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PubMed1999

Elbow revision arthroplasty in the situation of bone loss using an unlinked long-stem prosthesis.

The results of 16 first-revision operations using an unlinked cemented long-stem elbow arthroplasty in the situation of major bone loss are presented. Fifteen patients with a mean age of 62 years and longstanding polyarthritis were monitored for a mean period of 31 months (range, 6-62 months). Seven revision arthroplasties showed a good result and 7 a fair result with improvement of function and pain. Two patients with postoperative instability requiring further surgery had a poor result, with one infected prosthesis and one elbow with persistent instability and ulnar nerve hypersensitivity. Using a visual analog scale, patients documented good pain relief, good subjective independence, and a high level of satisfaction. In the follow-up SF-36 health survey, patients scored low physical function but good mental function. These results show that in the absence of infection and instability, revision elbow arthroplasty, even in the situation of major bone loss, can be a successful treatment option using this unlinked cemented long-stem system.

Adult↗
PubMed2005

A self-contained, mechanomyography-driven externally powered prosthesis.

The measurement of the low-frequency (5-50 Hz) "sounds" or vibrations produced by contracting muscles is termed mechanomyography (MMG). As a control signal for powered prostheses, MMG offers several advantages over conventional myoelectric control, including, nonspecific sensor placement, distal signal measurement, robustness to changing skin impedance, and reduced sensor costs. The objectives of this study were to demonstrate 2-function prosthesis control based on a triplet of distally recorded, normalized root mean square MMG signals and to identify necessary future research toward full clinical implementation of MMG signals in upper-limb externally powered prostheses. A novel self-contained MMG-driven prosthesis for below-elbow amputees was designed, implemented, and preliminarily tested on 2 subjects. This prosthesis was composed of specialized software and hardware modules that emulate a 2-site electromyography sensing system. Although the use of MMG signals for prosthesis control has been shown previously, we report, for the first time, successful control within a self-contained unit in unconstrained environments. Specifically, essential requirements for practical use, such as standardized sensor attachment, basic noise elimination, and miniaturization of the system, have been achieved. Both subjects were able to voluntarily open and close the prosthesis hand with no significant delays from intention to action (approximately 120 ms). Quantitative analyses revealed 88% and 71% control accuracy for subjects 1 and 2, respectively.

Adult↗
PubMed1998

Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis.

Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxation of the prosthesis, stiffness of the elbow, and problems with wound-healing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatment. Late complications (aseptic loosening, instability, and worn bushings) led to three poor results. None of the eighteen semiconstrained prostheses had radiographic evidence of loosening at the most recent follow-up evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a poor result.

Activities of Daily Living↗
PubMed1987

Revision total elbow arthroplasty.

Over a ten-year period, thirty-three consecutive revision total elbow arthroplasties were performed at our institution. These were assessed at a minimum of three years after the revision, with an average length of follow-up of sixty-one months. Eighteen (55 per cent) of the elbows had a good result and fifteen (45 per cent) had a poor result. The poor results were due to infection in three elbows, loosening of the prosthesis in six, inadequate motion in two, continued pain in two, and prosthetic failure in two. Additional surgical revision with another implant was done in the fifteen elbows that initially had a poor result. Eventually the result was good in twenty-four elbows. The three elbows that became infected after surgical revision had a resection arthroplasty and all were rated as having a fair result. The data from this study indicated that reimplantation is a viable option for the revision of a failed total elbow arthroplasty, although more than one revision may be required. They also suggested that young patients who have post-traumatic arthritis should not undergo a total joint replacement, and that revision procedures should be performed in settings that can offer several surgical options and by surgeons who have had experience with these options. Alternatives to reimplantation as a revision procedure should be considered in selected patients.

Arthritis, Rheumatoid↗
PubMed1987

Arthroplasty of the ipsilateral shoulder and elbow in patients who have rheumatoid arthritis.

Over a ten-year period, arthroplasty of the ipsilateral shoulder and elbow was performed in thirty-five extremities of thirty-one patients who had advanced rheumatoid arthritis. The results of the procedures were retrospectively reviewed to determine the appropriate sequence of surgery and the functional results that were obtained. All patients were followed for a minimum of two years after the last arthroplasty. The elbow had been operated on first in twenty-one extremities and the shoulder had been operated on first in fourteen. The time-interval between arthroplasties was significantly longer (p less than 0.005) when the elbow had been operated on first (forty-five compared with 13.4 months). All motion of the elbow and elevation and external rotation of the shoulder improved significantly (p less than 0.005), similar to the improvement in motion that is noted when either joint is operated on alone. Also, there was a highly significant reduction in pain and improvement in function (both, p less than 0.001). Review of the roentgenograms of twenty-three patients demonstrated no humeral fractures or interference in the proper placement of the humeral component of the prosthesis either by the stem of the other prosthesis or by the methylmethacrylate. All of the arthroplasties of the shoulder that were performed as the second arthroplasty were done at least five months after the arthroplasty of the elbow, and no dislocations or subluxations of the components of the elbow prosthesis occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Anatomic surface elbow arthroplasty. A preliminary report.

Whereas loosening of the humeral component of the semiconstrained hinged prosthesis has been reported as one of the major long-term complications of this type of elbow arthroplasty, the major complication related to the use of a semiconstrained nonhinged prosthesis is apparently an increased incidence of long-term dislocation of the ulnar and humeral components. The author has attempted to overcome this problem by including a radial head component for routine use with a three-piece, nonconstrained surface prosthesis for elbow arthroplasty. The importance of the radial head as a transmitter of vertical loading forces across the elbow joint is stressed. The apparent function of the radial head as a primary bony stabilizer of the elbow against valgus stress forces is also described. In addition to the radial head innovation, the new prosthetic design allows for ligament balancing by use of a system of articulating polyethylene spacers snapped onto the ulnar and radial head components. Preliminary results in 13 cases, with a mean follow-up period of 18 months, are noted. Although the author's clinical series is small and the postoperative follow-up period is short, the concepts related to the use of a radial head component and the improved ligament balancing by use of polyethylene articulating spacers seem to be valid.

Adult↗
PubMed2000

Functional outcome of semiconstrained total elbow arthroplasty.

BACKGROUND: The objective of the present study was to review the results of primary total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. Two hypotheses were tested: (1) the results in patients with inflammatory arthritis would be superior to those in patients with a traumatic or posttraumatic condition, and (2) the isometric extensor torque after total elbow arthroplasty would be significantly less than that of the contralateral elbow. METHODS: Forty-seven consecutive patients (fifty-one elbows) had the operation performed by one of three surgeons between November 1, 1989, and June 30, 1996. Thirty-six surviving patients (thirty-nine elbows) were available for follow-up. The mean duration (and standard deviation) of follow-up was 50 +/- 11 months (range, twenty-four to ninety-seven months). The mean age at the time of the operation was 64 +/- 11 years (range, twenty-seven to eighty-seven years). Eighteen patients (twenty-one elbows) had inflammatory arthritis. Eighteen patients (eighteen elbows) had an acute fracture or posttraumatic condition (posttraumatic osteoarthritis in eight, an acute fracture of the humerus in seven, nonunion of the distal aspect of the humerus in two, and primary osteoarthritis in one). The patients were evaluated with use of questionnaires (the Mayo elbow performance index, the Short Form-36 [SF-36], and the Disabilities of the Arm, Shoulder and Hand [DASH] Questionnaire); clinical examination by an orthopaedic surgeon who was not involved with the pre-operative, operative, postoperative, or follow-up care; radiographs; and elbow strength-testing with an isokinetic dynamometer. RESULTS: The mean score (and standard deviation) on the Mayo elbow performance index for the group that had inflammatory arthritis (90 +/- 11 points) was significantly higher than that for the group with a traumatic or posttraumatic condition (78 +/- 18 points) at the time of the latest follow-up (p < 0.05). In both groups, the mean extensor torque of the involved elbow was significantly less than that of the contralateral elbow (p < 0.05). No significant difference between the groups was found with respect to the flexion-extension arc of motion. Ten elbows (26 percent) had ulnar nerve dysfunction (a transient deficit in six and a permanent deficit in four); nine (23 percent), an intraoperative fracture (of the humeral diaphysis in four, of the ulnar diaphysis in four, and of the olecranon in one); three (8 percent), a periprosthetic infection; three, a triceps disruption; and one (3 percent), a revision because of a fracture of the ulnar component. There were no other revisions. Of the thirty-four elbows with complete radiographic follow-up, twenty-three had no change in the bone-cement interface. Progressive radiolucency was noted around the ulnar prosthesis in eight elbows, around the humeral prosthesis in one elbow, and around both components in two elbows. CONCLUSIONS: Patients who had a total elbow arthroplasty with use of a semiconstrained Coonrad-Morrey prosthesis were generally satisfied; the mean level of patient satisfaction was 9.2 of a possible 10 points for those who had inflammatory arthritis and 8.6 points for those who had a fracture or posttraumatic condition. The rates of complications involving the ulnar nerve, intraoperative fracture, triceps disruption, deep infection, and periprosthetic radiolucency are of concern.

Aged↗
PubMed1977

Total replacement of the elbow joint.

Total replacement of the elbow joint has been performed on 86 elbows at the Mayo Clinic, all but 15 in patients with rheumatoid arthritis. The Mayo design, which replaces both radiohumeral and humeroulnar joints, was used in 41 elbows, almost all in rheumatoid patients, with 71% good results. The Coonrad hinge with polyethylene bushings was used in 34 elbows; it was successful in 64% of rheumatoid patients, but failed in 46% of posttraumatic patients with bone loss. Previous designs have failed because of humeral loosening. Total elbow replacement is a technique still to be perfected in medical centers before general release.

Arthritis, Rheumatoid↗
PubMed2003

Semi-constrained total elbow arthroplasty in Chinese rheumatoid patients.

Seventeen Coonrad-Morrey semi-constrained total elbow replacements were performed on 14 Chinese rheumatoid patients. The elbows were reviewed retrospectively after a mean follow-up of 36 months (range 12-89 months.) After the operation, all patients were satisfied and there was no pain in 15 elbows. There was no radiological sign of loosening in the implanted prostheses and bone graft was incorporated in 93% of primary elbow replacements. The Mayo Elbow Performance Score was improved from an average of 40 (range 20-75) to an average of 93 (range 65-100). The arc of flexion was improved from an average of 89 degrees (range 0 degrees-125 degrees ) to 104 degrees (range 35 degrees-125 degrees ). The sizes of implants can be predicted accurately by the planning template in only four elbows (24%) and there were early complications in seven elbows (41%), with one prosthesis removed because of deep infection.

Adult↗
PubMed1993

Capitellocondylar total elbow replacement in rheumatoid arthritis. Long-term results.

We evaluated the long-term results of 202 capitellocondylar total elbow replacements that had been performed, from July 1974 through June 1987, in 172 patients. The duration of follow-up averaged sixty-nine months (range, twenty-four to 178 months). At the most recent follow-up examination, use of a 100-point rating score demonstrated an improvement from an average preoperative score of 26 points (range, 2 to 50 points) to an average postoperative score of 91 points (range, 45 to 100 points). The most improvement occurred in the categories of relief of pain, functional status, and range of motion in all planes except extension. The improvements in these categories and in the roentgenographic appearance that were seen in the early postoperative period did not deteriorate with time. The average preoperative arc of motion at the elbow ranged from -37 degrees of extension to 118 degrees of flexion. The average postoperative arc of motion at the elbow ranged from -30 degrees of extension to 135 degrees of flexion. Supination improved from 45 degrees preoperatively to 64 degrees postoperatively; pronation improved from 56 degrees preoperatively to 72 degrees postoperatively. The roentgenograms showed a radiolucent line adjacent to eight humeral and nineteen ulnar components; most of the lines were incomplete and one millimeter wide or less. Revision of the prosthesis was necessary in three elbows (1.5 per cent) because of loosening without infection, and in three additional elbows because of dislocation of the prosthesis. Complications included deep infection in three elbows (1.5 per cent); problems related to the wound in fifteen (7 per cent); permanent, partial sensory ulnar-nerve palsy in five (2.5 per cent); permanent, partial motor ulnar-nerve palsy in one (0.5 per cent); and dislocation in seven (3.5 per cent).

Adult↗
PubMed2006

[Elbow arthroplasty].

Each year, about 80 elbow arthroplasties are performed in Denmark. Approximately two thirds are done due to rheumatoid arthritis, the others due to comminuted fractures of the elbow, especially in elderly patients. The prosthesis is fixed with or without bone cement, and there are two different types of elbow prostheses: linked, in which the humerus and ulna are connected by a sloppy hinge, and non-linked, in which stability is dependent on the soft tissues of the elbow. Good pain relief can be expected, but the range of motion will usually be permanently affected.

Adult↗
PubMed2001

[Failure of upper limb macro-implantations: surgery and outcome. 11 cases].

The failure of macro-implantation of the upper limb must not be considered as the end of a therapeutic method, but instead as a step in the functional rehabilitation of the upper limb. From a group of 24 patients that have been operated with a macro-implantation of the upper limb, we have seen 11 patients for who the reimplantation had failed. We have studied the surgical procedure of those failures, the mid-term evolution (prosthesis and operations), and a long-term evolution with the functional future of those patients. A surgical procedure with latissimus dorsi flap was necessary in six cases, in one hand to maintain a sufficient length of the stump for prosthesis and the other hand to preserve the articulation of the elbow. Nine patients on 11 were able to be "apparated" by a myoelectric prosthesis for the amputation below the elbow (seven cases), by prosthesis for the amputation above the elbow (two cases). On a long period of time (average time 51 months) only four patients had a permanent use of their prosthesis (myoelectric type). For us, the functional rehabilitation of the upper limb need two important elements: first a good quality of the stump with a sufficient length, and second an important motivation from the patient to live with his "new hand".

Adult↗
PubMed1990

Elbow hemiarthroplasty with 20-year follow-up study. A case report and literature review.

Hemiarthroplasty of the elbow with an endoprosthesis has been reported very infrequently; only about 20 cases have been reported previously in the literature. This case merits reporting because of the youth of the patient (age 19), the uniqueness of the prosthetic component, and the long-term follow-up observation. The patient had posttraumatic bony ankylosis of the elbow with a painful supracondylar pseudoarthrosis and loss of bone from the proximal metaphysis. A custom humeral endoprosthesis was inserted, and anatomic reconstitution of the sigmoid notch of the ulna was provided. Reasonably good, painless, stable motion was achieved, which has not deteriorated in the subsequent 21 years of observation. The clinical significance of this case is that in a nonweight-bearing hinged joint, endoprosthesis arthroplasty can be an excellent option when given the proper indications and carried out with meticulous planning.

Adult↗
PubMedDate not supplied

Five- to thirteen-year follow-up of the GSB III total elbow arthroplasty.

Between 1988 and 1995, the senior author performed total elbow arthroplasty in 28 elbows (23 patients) with the GSB III prosthesis. At the most recent follow-up, 7 patients had died (9 elbows) and 1 had the implant removed because of a deep infection. The remaining 18 elbows (15 patients) were available for clinical and radiographic review at a mean period of 7.6 years (range, 5.5-11.9 years). All 15 patients were satisfied with the results of their elbow replacement, with a mean Mayo elbow performance score of 91 (range, 75-100). The mean flexion/extension and supination/pronation arcs improved by 33 degrees and 67 degrees, respectively. Radiographic follow-up demonstrated progressive loosening in only 1 patient and no progressive loosening in those with an adequate cement technique. Mild or moderate lysis of the distal humeral or proximal ulnar components was noted in 10 elbows, and severe lysis of the distal humerus was seen in 1. Of the patients, 6 (21%) had mild complications: triceps avulsions in 3, superficial wound infections in 2, and an undisplaced fracture of the distal humeral medial condyle in 1. In 4 patients (14%) complications developed requiring reoperation, including exchange of the polyethylene bushing because of wear, debridement of synovitis, resection arthroplasty for deep infection, and exploration of an ulnar nerve palsy. In 2 additional patients (7%), persistent ulnar nerve paresthesias developed postoperatively. Of the 28 elbow replacements performed with the GSB III prosthesis, only 1 required revision because of loosening at a mean follow-up of 7.6 years. The results of this series of GSB III elbow replacements in patients with rheumatoid arthritis demonstrate reasonable survivorship of this prosthesis.

Arthritis, Rheumatoid↗