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PubMed2001

An anthropometric study of the radial head: implications in the design of a prosthesis.

The dimensions of the native radial head were measured in 28 cadaveric upper extremities and radiographs of the contralateral elbows of 40 patients who had received a radial head replacement. The mean difference between the maximum and minimum radial head diameters was 1.7 +/- 0.7 mm (range, 0.12-3.27 mm). This variability suggests that although the native radial head is not circular, it does not have a consistently elliptic shape. The native radial head also is variably offset from the axis of the neck (4.2 +/- 2.5 mm), suggesting that a radial head hemiarthroplasty that precisely replicates normal anatomy would be difficult to achieve. There was a poor correlation between the radial head diameter and the medullary canal of the radial neck, suggesting that a modular implant system should be considered.

Aged↗
PubMed1980

Silastic prosthesis in fractures of the head of the radius: long term follow up.

After a fairly long experience we asked ourselves what value should be attributed to replacement surgery of the head of the radius, using a Silastic endoprosthesis? An attempt is made to answer this question after following up our cases for many years. This has led us to two factual conclusions; the limited life of the prosthesis and the surprising tolerance of the elbow to regressive radiographic changes.

Adult↗
PubMed1982

Condylar nonunions of the elbow.

Between 1968 and 1978, 32 patients were seen with nonunion of distal humerus fractures in close proximity to the elbow: 25 were treated with open reduction and fixation of the nonunion, and seven patients were treated with excision of the distal fragments and total elbow arthroplasty. Of the 25 patients treated with open reduction and fixation, 22 had union at an average of 7.74 months. However, six of these patients needed secondary procedures for repeat bone grafting or revision of the fixation device. Two of the seven patients with total elbow arthroplasty needed reoperation for loose humeral components.

Adult↗
PubMed1992

Capitellocondylar total elbow replacement. A long-term follow-up study.

Fifty-one capitellocondylar elbow replacements were inserted in forty-one patients between 1976 and 1986. Thirty-nine patients had rheumatoid arthritis and two had traumatic osteoarthrosis. The average age of the patients at the time of the operation was fifty-six years (range, twenty-one to seventy-seven years). Thirty-one patients who had thirty-nine retained elbow prostheses had an average length of follow-up of 6.5 years (range, two to thirteen years). Flexion improved an average of 20 degrees; extension, 4 degrees; pronation, 22 degrees; and supination, 36 degrees. Relief of pain was complete in 85 per cent of the thirty-nine elbows, and in 15 per cent there was only mild pain. Noteworthy postoperative complications in the original fifty-one elbows included infection in four elbows (8 per cent), dislocation in three (6 per cent), and ulnar neuropathy in sixteen (31 per cent). Three elbows were revised: one for a humeral fracture, one for recurrent dislocation, and one for aseptic loosening. Aseptic loosening was evident on radiographs of two elbows; one patient was completely asymptomatic, and one had mild pain with deformity. The Souter zonal radiographic assessment system for identification of radiolucencies at the bone-cement interface was utilized; there was no significant difference in radiolucencies between ulnar components backed with metal and those that were not backed with metal. Kaplan-Meier cumulative survivorship analysis demonstrated that a functional prosthesis was retained in 88 per cent of the elbows at 1.4 years postoperatively and in 83 per cent at 5.5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[Biomechanics of the normal elbow and following total semi-constrained arthroplasty].

The elbow possesses two degrees of freedom: flexion-extension and pronation-supination. The axis of flexion-extension joins the centers of the capitellum and of the trochlea. The axis of pronation-supination passes through the head of the radius, and through the distal ulnar dome. The functional elbow mobilities include 100 degrees of elbow flexion (30 to 130 degrees) and 100 degrees of forearm rotation (50 degrees of pronation and 50 degrees of supination). The elbow is submitted to high articular contact forces. The joint stability depends on the articular surfaces, capsulo-ligamentous restraints and dynamic muscular contractions. As a practical application of this fundamental knowledge, an experimental study of the effects of total elbow arthroplasty on joint stability and muscle moment arms is reported, insisting on the deleterious effects of implant malpositioning.

Biomechanical Phenomena↗
PubMedDate not supplied

A modified posterior approach to the elbow for total elbow replacement.

Fifty-nine consecutive primary total elbow replacements were performed with the modified posterior approach. The approach differs from other described approaches. The fascia and periosteum over the subcutaneous border of the ulna are preserved, and dissection is carried out on either side of the ulna. This enables a more secure repair of the posteromedial and posterolateral muscle compartments. The ulnar nerve is mobilized to prevent any injury. The distal humerus and proximal ulna can be fully exposed by this approach, giving wide access so necessary for accurate positioning of the prosthesis. The overall complication rate in 59 total elbow replacements was 33.9% including 4 (6.7%) ulnar nerve palsy, 4 (6.7%) wound infections, 2 (3.3%) delayed healing, 4 (11.8%) diminished range of motion in the affected elbow, 2 (3.3%) instability (1 had dislocated elbow and 1 had subluxation), and 1 (1.7%) triceps dehiscence requiring exploration and repair. All the patients could perform active resisted extension of the elbow, indicating continuity of the triceps. The senior author (SCG) has been using this approach for the Roper-Tuke unconstrained total elbow replacement for the last 15 years, and it has been associated with a lower incidence of complications. This approach has not been described before and is recommended for total elbow replacement.

Arthroplasty, Replacement↗
PubMed1987

Fractures of the radial head and lesions of the lower radius and ulna in the adult: the importance of the prosthesis in resection.

Multi-fragmentary fracture of the head of radius is a common lesion of the elbow; and resection of the head is justified either in isolation or to be completed with prosthetic implant replacement. From a study of 25 hospital records of patients treated at the Orthopedic and Traumatology Center of CRAM of Strasbourg with an average post-operative follow-up of 8 years, it appears that the habitual complications secondary to simple resection of the radial head, in particular cubitus-valgus, ascension of radial shaft and dysfunction of the inferior radio-ulnar articulation, are not observed after prosthetic replacement. Furthermore, whenever an injury of the latter articulation exists concomitant with radial head trauma, no further secondary aggravation ensues following replacement. Arthroplasty seems to be, hence, at the present moment the operation of choice for serious fractures of the radial head in cases where osteosynthesis is not possible and which used to be indications for simple resection.

Adolescent↗
PubMed1998

Lessons from 494 permanent accesses in 348 haemodialysis patients older than 65 years of age: 29 years of experience.

Currently, patients older than 65 years of age constitute more than 42% of all new enrolments for dialytic treatment in the USA and Italy. Most of these patients are treated by in-centre haemodialysis (HD), with problems connected to vascular access. Personal experience of 494 new vascular accesses in 348 'difficult' HD-patients older than 65 years over 29 years showed the best results from 221 elbow fistulas in comparison with 32 forearm fistulas (78% vs 57.2% at 3 years; P < 0.05). Among various vascular substitutes, the homologous saphenous vein (HSV) graft, alone or mixed (MX) gave the best secondary patency in comparison with other organic-semiorganic (OSO) or synthetic graft (SYN) angioaccesses with values of 59.4% for HSV, 66.3% for MX, 21.9% for OSO, and 38.6% for SYN grafts, respectively at 3 years.

Aged↗
PubMed2001

Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow.

BACKGROUND: The purpose of this study was to evaluate the stabilizing effect of radial head replacement in cadaver elbows with a deficient medial collateral ligament. METHODS: Passive elbow flexion with the forearm in neutral rotation and in 80 degrees of pronation and supination was performed under valgus and varus loads (1) in intact elbows, (2) after a surgical approach (lateral epicondylar osteotomy of the distal part of the humerus), (3) after release of the anterior bundle of the medial collateral ligament, (4) after release of the anterior bundle of the medial collateral ligament and resection of the radial head, and (5) after subsequent replacement of the radial head with each of three different types of radial head prostheses (a Wright monoblock titanium implant, a KPS bipolar Vitallium [cobalt-chromium]-polyethylene implant, and a Judet bipolar Vitallium-polyethylene-Vitallium implant) in the same cadaver elbow. Total valgus elbow laxity was quantified with use of an electromagnetic tracking device. RESULTS: The mean valgus laxity changed significantly (p < 0.001) as a factor of constraint alteration. The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head (11.1 degrees +/- 5.6 degrees). Less laxity was seen following release of the medial collateral ligament alone (6.8 degrees +/- 3.4 degrees), and the least laxity was seen in the intact state (3.4 degrees +/- 1.6 degrees). Forearm rotation had a significant effect (p = 0.003) on valgus laxity throughout the range of flexion. The laxity was always greater in pronation than it was in neutral rotation or in supination. The mean valgus laxity values for the elbows with a deficient medial collateral ligament and an implant were significantly greater than those for the medial collateral ligament-deficient elbows before radial head resection (p < 0.05). The implants all performed similarly except in neutral forearm rotation, in which the elbow laxity associated with the Judet implant was significantly greater than that associated with the other two implants. CONCLUSIONS AND CLINICAL RELEVANCE: This study showed that a bipolar radial head prosthesis can be as effective as a solid monoblock prosthesis in restoring valgus stability in a medial collateral ligament-deficient elbow. However, none of the prostheses functioned as well as the native radial head, suggesting that open reduction and internal fixation to restore radial head anatomy is preferable to replacement when possible.

Aged↗
PubMed2006

Revision of failed total elbow arthroplasty with use of a linked implant.

We studied retrospectively the results of revision arthroplasty of the elbow using a linked Coonrad-Morrey implant in 23 patients (24 elbows) after a mean follow-up period of 55 months. According to the Mayo Elbow Performance Score, 19 elbows were satisfactory, nine were excellent and ten good. The median total score had improved from 35 points (20 to 75) before the primary arthroplasty to 85 points (40 to 100) at the latest follow-up. There was a marked relief of pain, but the range of movement showed no overall improvement. Two patients had a second revision because of infection and two for aseptic loosening. The estimated five-year survival rate of the prosthesis was 83.1% (95% confidence interval 61.1 to 93.3). Revision elbow arthroplasty using the Coonrad-Morrey implant provided satisfactory results but with complications occurring in 13 cases.

Adult↗
PubMed1987

Results of total elbow arthroplasty as a salvage procedure for failed elbow reconstructive operations.

Total elbow arthroplasty (TEA) was used as a salvage procedure following failed open reduction and internation fixation, failed triaxial arthroplasties, and septic and aseptic loosening of implant arthroplasty. A minimally constrained bicondylar implant with a block to disarticulation was substituted for the reconstruction of 20 revision TEAs. Custom-designed implant TEA was substituted in cases with substantial bony or soft tissue loss. Revision of the polyethylene-bearing component, coupled with the addition of a yolk-type locking mechanism, was implanted when only the bearing system of a well-fixed implant had failed. TEA can be performed successfully with satisfactory durability as a revision procedure. Revision of failed open reduction internal fixation or a failed bearing system was highly successful. Revision of previously infected elbows in a single-stage procedure was unsuccessful in two of three cases and has been abandoned in favor of a staged procedure. A revision of loose TEA was successful in only three of five cases. Further investigations are necessary to improve the function durability of TEA.

Arthroplasty↗
PubMed1997

Elbow allograft for reconstruction of the elbow with massive bone loss. Long term results.

Transplantation of total elbow allografts has been used as a salvage procedure in an attempt to provide patients with functional, painless range of motion of the elbow. This procedure is appropriate for patients with massive bone loss after trauma, tumor resection, or revision elbow arthroplasty. During the past 20 years, 23 patients have undergone elbow allograft reconstruction with variable results and a high complication rate. Ten of 14 patients with elbow allografts observed for an average of 7.5 years report satisfactory results. Allograft removal was required in six patients: for infection (two), instability (three), and nonunion and resorption (one). Three patients with instability have since undergone successful total elbow arthroplasty. Two patients have been observed less than 1 year and another patient died during the study period. Complications occurred in 16 of 23 patients. This operation is not recommended for routine use and is viewed as a salvage procedure. The use of allografts in elbow reconstruction does not preclude subsequent reconstruction with another allograft or fusion. In patients with deficient bone stock, the allograft reestablishes bone mass to permit an arthrodesis or reconstructive arthroplasty.

Adult↗
PubMed2004

Revision total elbow arthroplasty with impaction allografting and uncemented partially hydroxyapatite-coated custom-made prostheses.

Total elbow arthroplasty has become a relatively common procedure in the last decade, and the number of primary total elbow replacements performed is likely to continue to increase as the population ages. The incidence of technically demanding prosthesis revisions involving complex problems such as major bone loss is therefore expected to increase. We report 3 cases of total elbow revision arthroplasty, all of which represented patients with severe bone loss. They were all treated using the impaction allografting technique and uncemented custom-made semiconstrained prostheses partially coated with hydroxyapatite manufactured at the bioengineering department of our institution.

Aged↗
PubMed1983

Total joint replacement in the upper extremity.

Prosthetic replacement of the joints of the upper extremity relieves pain, mitigates deformity, and improves function. As newer designs of prostheses are tested, we expand our knowledge of the biomechanics of each joint. Newer materials are rapidly changing the variety of implants on the market and improving prosthetic function. The problem of fixation of the noncemented prostheses to viable bone tissue remains one of the major unanswered questions for orthopedic surgeons today. Extensive research around the world is underway; different means of providing the environment that allows biologic ingrowth with fixation of a prosthesis are being investigated, thus avoiding the use of methyl methacrylate and its inherent problems.

Arm↗