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PubMed2004

Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty.

BACKGROUND: The growing frequency of joint arthroplasty has led to increasing numbers of patients requiring revision surgery. In the treatment of a failed total elbow arthroplasty not associated with infection, one of the main issues is poor or absent proximal ulnar bone stock due to osteolysis. We report our experience with the use of strut allograft reconstruction of the proximal part of the ulna as an adjunct to revision total elbow arthroplasty with a noncustom implant. Our aim was to better define the indications, outcomes, and complications of this technique in a population of patients with a failed total elbow arthroplasty. METHODS: We reviewed the cases of patients with aseptic failure of a total elbow replacement and proximal ulnar bone deficiency who were treated with allograft bone struts. The patients had had an average of 2.5 (range, one to four) prior open osseous operations addressing the elbow joint. In addition to revision of the prosthetic components, the deficient bone stock was treated with allograft strut grafts in one of four ways: (1) discrete cortical defects were contained, (2) periprosthetic fractures were splinted, (3) deficient triceps attachments were reconstructed, and (4) expanded segments were augmented with struts and filled with impaction graft. Twenty-one patients (twenty-two elbows) were followed for an average of four years (range, two to eleven years). RESULTS: The mean Mayo Elbow Performance Score improved from 34 points preoperatively to 79 points at the time of the latest follow-up. The scores for pain, stability, and activities of daily living improved most; there was little change in motion. Complications, consisting of four soft-tissue and four osseous problems, occurred in eight patients. Three patients had incorporation of 26% to 50% of the graft; five, 51% to 75%; and fourteen, 76% to 100%. CONCLUSIONS: Most deficiencies of proximal ulnar bone stock and fractures complicating revision total elbow surgery can be treated with allograft strut grafting. Although the complication rate is high, this technique is suitable for discrete cortical lesions, periprosthetic fractures, and an expanded proximal part of the ulna, which also requires augmentation with impaction grafting. The technique has been unreliable, however, in restoring deficient olecranon bone stock.

Arthroplasty, Replacement↗
PubMed1992

The Souter-Strathclyde elbow replacement in rheumatoid arthritis. 13 patients followed for 5 (1-9) years.

13 Souter-Strathclyde unconstrained elbow prostheses for rheumatoid arthritis were followed for 5 (1-9) years. Pain relief was achieved in all the patients. Flexion-extension was increased by 22 degrees, and pronation/supination by 27 degrees. There were no infections. Three humeral components were radiographically loose, but no patient had any symptoms. One patient sustained a fracture of the distal humeral epicondyle, two patients developed neuropathies and one patient had a postoperative dislocation that needed treatment with an external Hoffman fixator.

Aged↗
PubMed1976

[Report on a two-year experience with an ultrasterile operatory (author's transl)].

2,078 orthopaedic operations were carried out. No infections were observed at 640 hip-joint total endoprosthesis, 26 knee-joint endoprosthesis and 185 osteosynthesis. One primary infection happened in one case only, namely at an elbow-joint endoprosthesis. The compressed air installation, which drives the airturbines, was found to be the reason for the air not being germ-free what caused the infection. It is important that the turbines operate with germ-free air, and that the air recycling equipment is air-tight. The germ-free air of the horizontal displacement flow in an ultra-sterile operatory gives optimum ambient conditions for the operations, particularly when alloplastic interventions with big extraneous objects entail the risk of infections. After also many hours of operation, the air germination was extremely low and practically insignificant and cannot be obtained at such a low degree for conventionally air-conditioned operatories.

Antisepsis↗
PubMed2005

Semi-constrained total elbow arthroplasty for the treatment of rheumatoid arthritis of the elbow.

INTRODUCTION: We retrospectively reviewed the results of total elbow arthroplasty in patients with rheumatoid arthritis of the elbow followed for a minimum of two years. METHODS: Between September 1999 and March 2001, seven patients with rheumatoid arthritis of the elbow were treated with total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prostheses. One patient died 19 months after her surgery and was excluded from the study. Two patients had bilateral total elbow replacements. Eight elbows were thus available for review. The mean age of our patients at the time of surgery was 55.5 years. The indication for surgery was severe pain and stiffness in six elbows, and distal humerus fractures in two elbows. RESULTS: The mean duration of postoperative hospitalisation stay was 6.6 days. The average length of follow-up was 39.4 months. Six elbows had no pain, while two elbows had mild pain. The mean arc of flexion was 101.3 degrees. The mean Mayo elbow performance score was 93.1 points. Excellent results were achieved in six elbows, while two elbows had good outcome. There was one case of intraoperative lateral condylar fracture treated with internal fixation. One patient developed blisters postoperatively but resolved with dressings and antibiotics. CONCLUSION: Our small study revealed good to excellent short-term outcome with the use of semi-constrained total elbow arthroplasty for the treatment of rheumatoid arthritis of the elbow in Asian patients.

Aged↗
PubMed2006

Survival analysis and longterm results of elbow synovectomy in rheumatoid arthritis.

OBJECTIVE: To evaluate longterm results and survival rate of open synovectomy of the elbow joint in patients with rheumatoid arthritis (RA). METHODS: Between 1986 and 2000, synovectomy of the elbow was performed on 103 joints in 92 patients with RA. Eighty-five joints were included in this study. Mean age at time of surgery was 52 years (range 13 to 62 yrs). On 13 elbows with Larsen stage I and II disease, early synovectomy preserving the radial head was performed; in 72 cases with Larsen stage III and IV, late synovectomy with radial head resection was necessary. RESULTS: In early synovectomy, one joint received prosthetic joint replacement and 2 joints underwent resynovectomy a mean of 9 years after primary surgery. The survival rate (no further operations) was 91% after 5 years and 78% after 10 years. In late synovectomy, 16 elbow joints were operated again a mean of 4.6 years after primary surgery (10 prosthetic joint replacements, 2 resection interposition arthroplasties, 4 resynovectomies). Survival rate was 82% after 5 years and 66% after 10 years. Sixty-one elbows were examined clinically at a mean followup period of 8.7 years (range 2.8-17.3 yrs). There was a significant improvement of the Morrey score at followup, especially due to effective relief of pain. Improvement of joint motion was seen in late synovectomy for pronation and supination. The mean preoperative Larsen stage was 3.11, which decreased significantly to 3.66 at followup. CONCLUSION: Our findings suggest that synovectomy is a safe and effective procedure in differential treatment of RA of the elbow.

Activities of Daily Living↗
PubMed1991

Capitellocondylar total elbow replacement for rheumatoid arthritis.

In all, 23 capitellocondylar total elbow replacements were performed in 18 patients with rheumatoid arthritis. Follow-up was for a mean (range) of 3 (1.5-5) years. Pain relief was achieved in all patients and the postoperative range of movement showed an improvement in all directions. No evidence of radiological loosening has been seen. Complications consisted of a transient ulnar nerve palsy in 15 elbows (65%) and a permanent ulnar nerve palsy in one elbow (4%). In two elbows there was delayed wound healing.

Aged↗
PubMed1990

Results of reconstruction for failed total elbow arthroplasty.

Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory soft-tissue arthroplasty without the use of an interpositional material. When the epicondylar ridges were not retained and there was marked instability, the patients did not achieve satisfactory results.

Adult↗
PubMed1988

Total elbow replacement.

The historic development of prosthetic total elbow arthroplasty is traced and results of constrained, semiconstrained, and nonconstrained designs reported. The authors' personal experience with the semiconstrained total elbow replacement, surgical indications with an emphasis on careful patient selection, and highlights of operative technique are discussed. Pain, instability, ankylosis, and arthritic degeneration of the elbow have inspired many surgical attempts to improve function and relieve pain. The most sophisticated surgical options now include total elbow replacement. This paper reviews the development of total elbow arthroplasty and assesses the experience with semiconstrained total elbow replacements performed at the New York University Medical Center over the last eight years.

Adult↗
PubMed1987

[Reconstructive plastic surgery of the humeral condyles following removal of endoprostheses of the elbow versus arthrodesis].

The condyles of the elbow are of utmost importance for the stability of this joint. This is particularly evident in cases where elbow prostheses had to be removed because of loosening or infection and where the condyles had been deliberately resected at the primary operation. In order to obtain a functional elbow with sufficient stability and mobility after removal of the prostheses, we can reconstruct the condyles by means of a large autologous bone graft, which we take from the midpart of the illiac bone. The fixation is done with a specially adapted plate rather than with screws. A few case examples with a longer follow-up are presented for whom the result was very gratifying. We also insist on the great importance of solid fixation of fractured condyles, particularly in cases of resection arthroplasty. Elbow arthrodeses should only be used where there is no chance of obtaining a sufficiently satisfactory result by means of an arthroplasty. In these rare cases, we have been using internal fixation with an adapted AO plate and the interposition of an autologous bone graft. In the future replantation of prostheses, possibly on neocondyles will become more important.

Arthrodesis↗