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PubMed1986

A critical analysis of mechanical factors correlated with bone remodeling following total elbow arthroplasty.

Thirty elbows were critically reviewed for quantitative evidence of bone remodeling, with demonstrable bone remodeling noted in more than one half of the ulnae and humerii. Bone remodeling was analyzed statistically with independent variables of age, sex, handedness, diagnosis, implant design considerations, and implant alignment. Only implant design and alignment had a statistically significant impact on bone remodeling. Periarticular (zone 1) bone loss was statistically significantly correlated with a high percentage of diaphyseal medullary canal occupied by prosthesis, the presence of assymetric stem cortical contact, and lack of metaphyseal (zone 1) load transfer. Diaphyseal bone hypertrophy (zone 4) was statistically significantly correlated with a high percentage of diaphyseal medullary canal occupied by prosthesis (zone 4) and assymetric stem tip-to-cortical wall contact. Periarticular bone hypertrophy and diaphyseal bone atrophy did not occur. Fractures through the humeral condyles occurred in three elbows undergoing bone atrophy, but no implant loosening or failure could be correlated with bone remodeling. Bone remodeling does occur in a high percentage of stemmed elbow implants but to date has not been a factor in clinical failure.

Atrophy↗
PubMed1993

[Treatment of proximal humeral tumor: a case report].

In management of malignancy of the proximal humerus, amputation or a complete flail limb both give poor functional results. The limb-salvage procedure with joint reconstruction preserves function in the elbow and hand, thereby improving the quality of remaining life for patient. Prosthetic humeral replacement may avert amputation and preserve a functional arm, but neither segmental modular proximal humeral prosthesis nor custom-made prosthesis is readily available here. Combining the Neer II shoulder prosthesis and Kuntscher's nail with acrylic cement can replace the proximal humerus with an adjustable length of stem within the humeral shaft. A piece of mesh is incorporated into the prosthesis, placed around the neck of the Neer II shoulder prosthesis, and sutured to the rotator cuff to prevent subluxation of the humeral head and preserve some function of the rotator cuff. The above prosthetic humeral replacement has been applied to one patient with a primary osteosarcoma. It preserved the function of the elbow and hand well. One year post-operatively, there was no dislocation or subluxation. Details of procedures used are given.

Bone Neoplasms↗
PubMedDate not supplied

Successful outcome of the Souter-Strathclyde elbow arthroplasty.

This study describes a consecutive series of 68 primary Souter-Strathclyde elbow replacements performed in a predominantly rheumatoid population, compares survivorship and complication profile with published series, and analyzes factors associated with successful outcome. Survivorship at 10 years was 74%, with at least 5 years' follow-up in 25 prostheses and a satisfactory Mayo score in 92% of all 68 elbows. These results compare acceptably with those from specialized elbow units. Careful component selection with regard to joint stability and bony fixation are important factors in the successful outcome of the Souter-Strathclyde arthroplasty. Use of a long-stemmed prosthesis was associated with a significantly better outcome after intraoperative fracture, and revision to a linked articulation was the most reliable treatment for instability.

Aged↗
PubMed1993

The Guildford elbow.

The Guildford elbow is a new unconstrained elbow arthroplasty. From 1985 to 1991, this arthroplasty was used in 24 patients with rheumatoid arthritis. The patients were reviewed after an average of 28 months (4-59 months). Good to excellent results were obtained in 95% regarding pain relief and functional improvement. Complications were few, with only one case of clinical loosening and three of radiological loosening. Ulnar nerve hypo-aesthesia was common but did not jeopardize the final result in any patient.

Adult↗
PubMed2003

The effect of metallic radial head arthroplasty on radiocapitellar joint contact area.

OBJECTIVE: This study determined the effect of metallic radial head arthroplasty on radiocapitellar joint contact area. DESIGN: The contact area of eight intact radiocapitellar joints was assessed during simulated compressive loading. Subsequently, the same experiments were repeated after reconstruction with three different radial head implant sizes. BACKGROUND: There has been an increasing use of metal radial head implants relative to silicone implants. However, the contact characteristics with the metal reconstruction have not been determined. METHODS: A 100 N compressive load was applied to the radiocapitellar joint at three different flexion angles for the native joint and three different sizes of a metal head implant. An impression material was employed to quantify joint contact area. RESULTS: Following metallic radial head arthroplasty, the contact area decreased by approximately two-thirds relative to the native radiocapitellar joint (P<0.001). Smaller implant sizes resulted in slightly larger contact areas (P<0.05). In addition, contact area decreased as joint flexion angle increased (P<0.04). CONCLUSIONS: Selection of radial head implant size is likely not a significant factor with regard to contact area mechanics of the radiocapitellar articulation. RELEVANCE: The effect of radial head implant size on the contact area produced with the native capitellum is not known. This study shows that the design or selection of a metallic radial head implant from the viewpoint of size is likely not an important factor with regard to minimizing joint contact stresses.

Aged↗
PubMed2000

Ipsilateral total shoulder arthroplasty and total elbow replacement arthroplasty: a caveat.

Shoulder and elbow replacement arthroplasty both achieve a high degree of success in patients with inflammatory arthritis. When both arthroplastics are performed on the same side, a stress riser can occur in the humeral diaphysis between the tips of the 2 humeral components. When the shoulder arthroplasty is performed first, a short-stemmed humeral component is advised. If a long-stemmed humeral component at either joint is already in place, the cement column for the subsequent arthroplasty should extend to and include the cement column of the extant component.

Adult↗
PubMed1990

Total elbow arthroplasty.

The results of 36 total elbow arthroplasties in 32 patients are presented. The follow-up period ranged from 3 to 12 years. The preoperative diagnosis was rheumatoid arthritis in 27 patients and posttraumatic degenerative joint disease in 5. There were 23 women and 9 men. Unconstrained prostheses (London) were implanted in 6 elbows, semiconstrained prostheses (MAYO, AMC, and triaxial) in 26, and constrained prostheses (GSB, Schlein) were used in 4. There were five perioperative fractures (14%) that were successfully treated nonoperatively. Three ulnar nerve neuropraxias occurred (8%), one of which required surgical exploration and repeat anterior transfer of the nerve. Two superficial postoperative infections (6%) responded to nonoperative treatment. Major complications necessitating revision surgery occurred in 18 (50%). Loosening of the prostheses occurred in nine (25%); two were treated by reimplantation, with prosthetic removal in the others. Deep infections in four (11%) and dislocations occurring in two (6%) necessitated prosthetic removal. Traumatic fractures occurred in two (6%); one was successfully treated by internal fixation, while the other failed internal fixation, requiring prosthetic removal. Radiolucent lines were seen in 20 (56%).

Adult↗
PubMed1986

Total elbow arthroplasty in the face of significant bone stock or soft tissue losses. Preliminary results of custom-fit arthroplasty.

There is a class of patients with severe bone stock or soft tissue losses who remain an unsolved problem in elbow reconstruction. The authors report the results of 16 such patients who underwent 16 total elbow replacements. Follow-up averaged 4.0 years (range, 2.0-9.6 years). Fourteen patients had previous surgery on their elbows and three had been previously infected. Fourteen of the 16 patients had a good or excellent result, and overall elbow scores averaged 90 (range, 53-100). There were three reoperations and one case of nonprogressive circumferential lucent lines about a humeral component with clinical symptoms. There were no other cases of clinical or radiographic implant loosening and no implant fractures. The preliminary results of this study indicate that custom-fit total elbow arthroplasty offers acceptable functional results in a devastated elbow when normal methods of reconstruction are not suitable.

Elbow Joint↗
PubMed2001

Intraosseous radial nerve entrapment complicating total elbow revision.

A 43-year-old man underwent revision of a loose total elbow arthroplasty in 1995. The arthroplasty had been implanted 20 years previously for post-traumatic osteoarthritis after a gunshot wound complicated by permanent ulnar nerve palsy. The patient suffered a minimally displaced periprosthetic fracture 4 years after implantation that was treated closed. The patient subsequently developed severe loosening with bony dilation. During revision surgery, while grasping and removing the periprosthetic membrane from within the humeral medullary canal with a Kerrison rongeur, dorsiflexion of the wrist and hand occurred. Close inspection of the membrane revealed that the radial nerve was encased inside the bone. Although not divided, the traction and contusion of the nerve caused a radial nerve palsy that partially resolved by 4 years of follow-up.

Adult↗
PubMed1987

Endoprosthetic replacement of the humerus and elbow joint.

Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient.

Arm Injuries↗
PubMed1990

Silastic interposition for haemophilic arthropathy of the elbow.

Thirteen elbows affected by severe haemophilic arthropathy and treated by silastic interposition arthroplasty were followed up for at least five years. The severity of pain, the frequency and severity of spontaneous haemorrhage and the range of movement were assessed before operation and at review. All patients were much improved and needed less factor replacement. Three elbows were revised, one for infection and two because of fragmentation of the silastic sheet. They regained good function following revision.

Adult↗
PubMed2005

Survivorship of the Souter-Strathclyde elbow replacement in the young inflammatory arthritis elbow.

We divided 309 patients with an inflammatory arthritis who had undergone primary elbow replacement using the Souter-Strathclyde implant into two groups according to their age. The mean follow-up in the older group (mean age 64 years) was 7.3 years while in the younger patients (mean age 42 years) it was 12 years. Survivorship for three different failure end-points (revision, revision because of aseptic loosening of the humeral component, and gross loosening of the humeral implant), was compared in both groups. Our findings showed that there was no significant difference in the incidence of loosening when young rheumatoid patients were compared with an older age group.

Adult↗