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PubMed2006

Kudo type-5 total elbow arthroplasty in mutilating rheumatoid arthritis: a 5- to 11-year follow-up.

We studied 11 patients (14 elbows) with gross rheumatoid deformity of the elbow, treated by total arthroplasty using the Kudo type-5 unlinked prosthesis, and who were evaluated between five and 11 years after operation. Massive bone defects were augmented by autogenous bone grafts. There were no major complications such as infection, subluxation or loosening. In most elbows relief from pain and stability were achieved. The results, according to the Mayo Elbow Performance Score, were excellent in eight, good in five and fair in one. In most elbows there was minimal or no resorption of the grafted bone. There were no radiolucent lines around the stems of the cementless components. This study shows that even highly unstable rheumatoid elbows can be replaced successfully using an unlinked prosthesis, with augmentation by grafting for major defects of bone.

Adult↗
PubMed2001

The anatomic features of the radial head and their implication for prosthesis design.

OBJECTIVE: To establish the anatomical features of the radial head of an average normal human being and to verify the hypothesis that no significant difference exists between the geometry of the left and right normal radial heads. DESIGN: 17 proximal ends of the radius from the left and right forearms of fresh male (average age 50 and range 40-70) cadavers were measured. BACKGROUND: A reconstruction of anatomical features of the normal bone is important for prosthesis design. METHODS: A morphologic study of the radial head was performed using a co-ordinate measuring machine integrated with a computer aided design system. For comparative purposes, a statistical analysis including linear regression and correlation was performed. RESULTS: The maximum diameter (mean 23.36 mm (SD, 1.14 mm)) and height (mean 10.14 mm (SD, 1.38 mm)) of the radial head as well as the depth (mean 1.92 mm (SD, 0.32 mm)) and maximum radius (mean 20.27 mm (SD, 4.61 mm)) of the concave articulate surface are the most important anatomical features, which should be implicated in prosthesis design. The inclinations mean 2.50 degrees (SD, 0.41 degrees ) and mean 9.50 degrees (SD, 0.52 degrees ) and shift (mean 1.71 mm (SD, 0.35 mm)) of the radial head relative to its neck should also be taken into account in prosthetic design. CONCLUSIONS: The results of the study showed that "left is equal to right" (no significant differences between sides were obtained, for probability value P>0.05). RELEVANCE: This paper describes a morphological study of the proximal radius. The results can be used to reconstruct the geometry of the injured radial head based on the obtained geometric features of the contra-lateral side. These results can be also used to design radial head prosthesis.

Adult↗
PubMed1985

Electrically powered prostheses for the adult with an upper limb amputation.

The value of fitting adult upper limb amputees with electrically powered prostheses is assessed. In a series of 164 amputees, complete or useful acceptance of an electrically powered prosthesis was recorded in 80% of below-elbow amputees, 69% of above-elbow amputees and 72% of high level amputees. Patients expressed satisfaction with the combination of comfort, cosmesis and function. Results indicate that, accepting the high cost, an electrically powered prosthesis can provide important function to the upper limb amputee.

Adolescent↗
PubMed2005

Treatment of sequelae of radial head fractures with a bipolar radial head prosthesis: good outcome after 1-4 years follow-up in 11 patients.

BACKGROUND: In the presence of additional disruption of the distal radioulnar ligaments, the interosseous membrane, or the lateral- and/or medial collateral ligament, radial head fractures treated by resection will result in valgus elbow instability, proximal radial migration and/or posterolateral rotatory instability. Radial head replacement has been used to treat or prevent this. We report our experience with the Judet CRF II radial head prosthesis. PATIENTS AND METHODS: We treated 11 patients with a bipolar radial head prosthesis because of elbow instability after previous treatment for Mason-Johnston type III or IV radial head fractures. The outcome was assessed clinically using two standardized elbow function assessment scales, and radiographically after a mean follow-up of 2 years. RESULTS: Clinical outcome was either good or excellent in all patients; all elbows were stable. Radiographically, there were no signs of loosening, fracture or heterotopic ossification. 2 patients required reoperation for subluxation of the prosthesis; both were treated by reducing the size of the modular head of the prosthesis. There was erosion of the capitellum in 1 patient. INTERPRETATION: Bipolar radial head replacement can be used successfully for treatment of the sequelae of radial head fractures. The long-term outcome is, however, unknown.

Adult↗
PubMed1998

[Prostheses of the head of the radius. What outcome can be expected?].

We report our results after primary implantation of 30 radial head prostheses in a retrospective study from 1978 to 1996. If there was intraoperatively a remaining instability of the elbow after resection of the radial head, we implanted a prosthesis. The average age of our patients was 40.7 years. The results were evaluated concerning the recommendations of Radin and Riseborough. In 22 patients (73%) we found good to satisfactory results, in 8 patients (27%), there was a free range of motion. Heterotopic ossifications with a remarkable decrease in the range of motion were discovered in 3 patients (10%). The implant had to be removed in three (10%) patients (2 incorrect implantations, one broken prosthesis). To conclude, the primary implantation of a radial head prosthesis after a strict indication improves the clinical benefit for the patient. A correct surgical technique avoids unnecessary complications.

Adult↗
PubMed1989

Total elbow arthroplasty for complete ankylosis of the elbow.

Sixteen patients who received nineteen semiconstrained total elbow replacements for complete ankylosis of the elbow were followed for an average of five and three-quarters years (range, two to twelve years). The average preoperative elbow score was 23 points and the average postoperative score was 84 points. Postoperatively, the average flexion was 115 degrees; extension, 35 degrees; and pronation and supination, 95 degrees. There were fifteen excellent or good results. There was one failure due to a deep infection, but after removal of the prosthesis a satisfactory fascial arthroplasty was achieved in this elbow. Function was improved in all patients, and all patients had relief of the preoperative pain. For the arthroplasty to succeed, the patient must have a good understanding of the procedure and must be willing and able to comply with the postoperative rehabilitation program. The use of a semiconstrained, often custom-fit, implant is necessary. The Bryan-Morrey posteromedial approach to the elbow is recommended for the procedure, since this approach allows early institution of range-of-motion exercises.

Adolescent↗
PubMed2006

Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis. This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.

Adolescent↗
PubMed1986

Prosthetic use in adult upper limb amputees: a comparison of the body powered and electrically powered prostheses.

Three hundred and fourteen adult upper limb amputees were reviewed retrospectively at the Ontario Workers' Compensation Board. A questionnaire was used to evaluate the use of body and electrically powered prostheses. Follow-up ranged from 1 to 49 years with a mean of 15 years. Results indicated that complete or useful acceptance of an electrically powered prosthesis was reported by 69 of 83 amputees (83%); 199 of 291 amputees (68%) used the cable operated hook, 57 of 291 (20%) used the cable operated hand and 40 of 83 (48%) used the cosmetic prosthesis. The majority of amputees used more than one prosthesis for their functional needs and should be fitted with more than one type of prosthesis. Acceptance of an upper limb prosthesis by 89% (196/220) of below-elbow, 76% (56/74) of above-elbow and 60% (12/20) of high level amputees indicates that for most upper limb amputees, their prostheses are well used and essential to their personal and employment activities.

Activities of Daily Living↗
PubMed1998

Clinical evaluation of a new, above-elbow, body-powered prosthetic arm: a final report.

The AdVAntage Arm is an above-elbow (AE) body-powered arm designed to improve upon, and overcome, some of the major limitations of conventional prostheses. It is the result of research and development (R&D) accomplished at the Center for Engineering Design (CED), University of Utah and Sarcos Research Corporation (SRC), Salt Lake City, UT. The AdVAntage Arm was developed to provide the following main features: lightweight, independent elbow and terminal device (TD) control, and a cable recovery system for full TD actuation at any elbow position. The Department of Veterans Affairs (VA) Rehab R&D Service's Technology Transfer Section (TTS), with collaboration from the VA National Prosthetic and Sensory Aids Service (PSAS), managed a multi-center clinical evaluation of the precommercial AdVAntage Arm (the Arm). The purpose was to objectively assess and affirm the Arm's functional advantages, reliability, clinical application, and commercial readiness. Eleven VA prosthetic services served as evaluation sites with a total of 16 subjects with amputation (14 unilateral and 2 bilateral). Fifteen prosthetists provided their comments. Overall, the results demonstrated that the Arm could be fit for use by persons with transhumeral, and even with forequarter, amputation. Once the learning curve was overcome, the majority of subjects reported that the Arm offered several functional advantages over their conventional prosthesis. Its overall light weight, separation of elbow and TD function, and cable recovery system allowed opening and closure of the TD at any elbow position; resulting in a more fluid manner of use and allowing subjects to perform more activities from waist level and above (especially in the outstretched and overhead positions). At the conclusion of clinical trials, 10 subjects elected to keep the Arm for continued use. The manufacturer is committed to the commercial marketing and technical support of the arm. Based upon the clinical findings, the AdVAntage Arm was recommended for commercial production and availability, upon prescription, to appropriate veteran beneficiaries.

Activities of Daily Living↗
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↗
PubMed2000

Fractures of the distal humerus: role of elbow replacement.

Rigid osteosynthesis and early motion is the well-accepted norm to treat distal humerus fractures. This article addresses the role of elbow replacement related to fractures of the distal humerus, including indications, technique, and results. For severe posttraumatic osteoarthrosis, total elbow replacement using the semiconstrained Coonrad-Morrey prosthesis has proven to be a suitable and reliable option for older patients.

Adult↗
PubMed1989

Factors related to successful upper extremity prosthetic use.

Surveys from 40 upper extremity amputees were analyzed to examine factors related to successful use of an upper extremity prosthesis. Factors which were associated with successful rehabilitation were fewer than two complicating factors, completion of high school education, employment at both the time of amputation and review, rapid return to work, acceptance of the amputation by the time of this review, and perception that the prosthesis was expensive. Factors which appeared unrelated to prosthetic success were age, loss of dominant hand, loss of elbow, marital status, use of rehabilitation services, use of a temporary prosthesis, and whether training in prosthetic use was provided. Many of these factors concurred with earlier studies. Previously unreported factors that may be of importance to the long-term success of upper limb amputees are the number of complicating factors and perceptions about the monetary value of the prosthesis.

Adult↗
PubMed1988

Side-swipe injury to the elbow.

A case with a "side-swipe" injury in the left elbow while projected out an automobile window, resulting in avulsion of the distal one third of the humerus and proximal two thirds of the olecranon, is reported. The bony defect was reconstructed by an endoprosthesis to preserve elbow function.

Accidents, Traffic↗
PubMed1991

The elbow.

Explore the source record for details and available documents.

Adult↗
PubMed1999

Total elbow arthroplasty with use of a nonconstrained humeral component inserted without cement in patients who have rheumatoid arthritis.

BACKGROUND: Most total elbow prostheses that are currently in use require cement for fixation of each component. We developed a new (type-5) prosthesis that does not need cement for fixation. METHODS: The humeral component is made of cobalt-chromium alloy, and its stem is porous-coated with a plasma spray of titanium alloy. There are two options for the ulnar component: an all-polyethylene type and a metal-backed type with a porous-coated stem. Forty-three elbows in thirty-seven patients who had rheumatoid arthritis were treated with total elbow replacement arthroplasty with use of the type-5 prosthesis. The humeral component was implanted without cement in all elbows, whereas the ulnar component was implanted without cement in eleven elbows and was fixed with cement in the remaining thirty-two. The elbows were followed for an average of three years and ten months (range, two years and six months to five years and six months). RESULTS: The clinical results were assessed according to a modification of the Mayo Clinic Performance Index. At the time of the latest follow-up, the overall result was excellent for six elbows, good for thirty-one, and fair for six. All elbows had been rated as poor before the operation. There was almost complete relief of pain in twenty-nine elbows and mild or occasional pain in the remaining fourteen. Flexion increased markedly, from an average of 104 degrees preoperatively to an average of 133 degrees postoperatively; this difference was highly significant (p < 0.001, Student t test). In contrast, extension (flexion contracture) worsened slightly, from an average of 38 degrees preoperatively to an average of 42 degrees postoperatively; this difference was significant (p < 0.05). There was one postoperative dislocation of the elbow, and ectopic bone formed in another, with recurrence of ankylosis. Both elbows had a reoperation, and a good result eventually was obtained. There were no instances of postoperative infection or neuropathy of the ulnar nerve. Radiographically, there were no radiolucent lines at the bone-metal interface of any of the humeral or ulnar stems that had been implanted without cement, suggesting solid fixation by osseointegration. CONCLUSIONS: The results of total elbow arthroplasty with use of this prosthesis appear promising. There was a high rate of relief of pain as well as of restoration of adequate function in patients in whom the elbow was severely affected by rheumatoid arthritis.

Adult↗
PubMed1975

Incidence of metal sensitivity in patients with total joint replacements.

Sensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements. Nineteen (38%) were sensitive to one or more of the metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa.

Chromium↗