Aims

The aims of this study were to identify and evaluate the current literature examining the prognostic factors which are associated with failure of total elbow arthroplasty (TEA).

Total elbow arthroplasty (TEA) usage is increasing owing to expanded surgical indications, better implant designs, and improved long-term survival. Correct humeral implant positioning has been shown to diminish stem loading in vitro, and radiographic loosening in in the long-term. Replication of the native elbow centre of rotation is thought to restore normal muscle moment arms and has been suggested to improve elbow strength and function. While much of the focus has been on humeral component positioning, little is known about the effect of positioning of the ulnar stem on post-operative range of motion and clinical outcomes. The purpose of this study is to determine the effect of the sagittal alignment and positioning of the humeral and ulnar components on the functional outcomes after TEA. Between 2003 and 2016, 173 semi-constrained TEAs (Wright-Tornier Latitude/Latitude EV, Memphis, TN, USA) were performed at our institution, and our preliminary analysis includes 46 elbows in 41 patients (39 female, 7 male). Patients were excluded if they had severe elbow deformity precluding reliable measurement, experienced a major complication related to an ipsilateral upper limb procedure, or underwent revision TEA. For each elbow, saggital alignment was compared pre- and post-operatively. A best fit circle of the trochlea and capitellum was drawn, with its centre representing the rotation axis. Ninety degree tangent lines from the intramedullary axes of the ulna and humerus, and from the olecranon tip to the centre of rotation were drawn and measured relative to the rotation axis, representing the ulna posterior offset, humerus offset, and ulna proximal offset, respectively. In addition, we measured the ulna stem angle (angle subtended by the implant and the intramedullary axis of the ulna), as well as radial neck offset (the length of a 90o tangent line from the intramedullary axis of the radial neck and the centre of rotation) in patients with retained or replaced radial heads. Our primary outcome measure was the quickDASH score recorded at the latest follow-up for each patient. Our secondary outcome measures were postoperative flexion, extension, pronation and supination measured at the same timepoints. Each variable was tested for linear correlation with the primary and secondary outcome measures using the Pearson two-tailed test. At an average follow-up of 6.8 years (range 2–14 years), there was a strong positive correlation between anterior radial neck offset and the quickDASH (r=0.60, p=0.001). There was also a weak negative correlation between the posterior offset of the ulnar component and the qDASH (r=0.39, p=0.031), and a moderate positive correlation between the change in humeral offset and elbow supination (r=0.41, p=0.044). The ulna proximal offset and ulna stem angle were not correlated with either the primary, or secondary outcome measures. When performing primary TEA with radial head retention, or replacement, care should be taken to ensure that the ulnar component is correctly positioned such that intramedullary axis of the radial neck lines up with the centre of elbow rotation, as this strongly correlates with better function and less pain after surgery

The aim of this study was to assess the long-term results of the Kudo type-5 total elbow prosthesis and compare the results of two types of cemented ulnar components. The Kudo type-5 unlinked total elbow prosthesis (Biomet UK Ltd, Bridgend Wales) was developed in 1993. The stem of humeral component is porous-coated with a plasma spray of titanium alloy for cementless use. The ulnar component may be metal-backed with a porous-coated stem or polyethylene alone; the latter designed mainly for cement use. A metal-backed type without a porous-coated stem designed for cement use also came into being after 2003. Between 1993 and 2010, the Kudo type-5 total elbow arthroplasty was performed on 364 elbows in 274 consecutive patients with rheumatoid arthritis. The mean age of the patients at the time of the operation was 60.7 (27–86) years. Twenty elbows had Larsen grade III, 224 had grade IV, and 120 had grade V changes pre-operatively. Before the operation, 346 elbows had severe or moderate pain, 95 had gross valgus-varus instability. Clinical symptoms and revision rates were assessed 4 to 20 years (mean, 9 years) postoperatively. The mean Mayo elbow performance scores were all poor except for three initially (mean overall score, 39.5 points). The overall score had improved substantially both at the early follow-up (1 to 3 years after the operation) and the latest follow-up (4 to 20 years after the operation), with 89.5 and 84.7 points, respectively. At the latest follow-up the overall result was excellent for 185 elbows, good for 103, fair for 11 and poor for 30, with almost complete relief from pain for 298. The arc of movement had increased from a mean of 85.7 °pre-operatively to 95.1 ° post-operatively, and to 98.1 °at the latest follow-up. Spot welds around the humeral stem suggesting solid osseous integration were often seen in the elbows with cementless fixation of the porous humeral stem. At the latest follow-up, implants were removed due to infection in 3 elbows. Twenty-five elbows required ulnar component revision due to loosening of the all-polyethylene component. Two elbows required ulnar component revision due to loosening of the metal-backed component. Seven elbows required humeral component revision due to loosening of the humeral components. One elbow required revision due to dislocation. A survival analysis with revision or removal of one or both components as the end point was performed according to the Kaplan and Meier method. The overall survival rate of the prosthesis was 75.2% at 19 years. The survival of 87.0% in the metal-backed group was higher than the 74.3% in the all-polyethylene group. Loosening of the all-polyethylene ulnar component was the main reason for deterioration in the long-term outcome. We conclude that the long-term results of the Kudo type-5 total elbow arthroplasty is acceptable and cemented fixation of metal-backed ulnar component had better long-term survival than the all-polyethylene component

Introduction: The Kudo total elbow prosthesis (TEP) is a well established implant, with good mid-term results. In the last decades this implant underwent several modifications. The last modification (type 5) has overcome the problems of stem breakage of the humeral component by modifications of the stem. The ulnar component can be placed with or without cement; the humeral component is always placed without cement. Aims of this study: To examine the mid-term results of the Kudo type 5 TEP and to compare the results of the uncemented Kudo total elbow prosthesis (TEP), with the hybrid Kudo TEP (uncemented humeral component and cemented ulnar component). Material and methods: Between 1994 and 2004 89 Kudo type 5 TEPs were placed for joint destruction due to rheumatoid arthritis (RA). The mean age of the patients was 55 years (range 21–84 years). Twenty-two prostheses were placed in males, 66 in females. Forty-nine TEPs (group 1) were fully uncemented and 40 TEPs (group 2) were hybrid (humeral component uncemented, ulnar component cemented). The groups were comparable as related to age, sex and indication for surgery. After implantation of the prosthesis a radiograph was made every two years or sooner when indicated. Evaluation took place after an average of 5.3 years of follow up (range 1.7–10.6 years) and consisted of a questionnaire, elbow function assessment and anteroposterior and lateral radiographs in a standard way. Pre- and postoperative range of motion was analysed with the paired T-test. Pain scores and EFAS scores postoperatively were analysed using the independent sample T-test. The survival of the prosthesis was calculated from the time of implant to the time of revision or occurrence of radiolucencies. Results: In group 1, seven ulnar components had to be revised due to aseptic loosening after a mean follow-up of 4 years (range 1.5–6.3 years). Three of these ulnar components were short-stemmed, four were long stemmed uncemented. In group 2 five patients died of an unrelated course and no revisions have taken place, one TEP is loose on X-ray (after two years) with a suspicion of septic loosening The EFAS scores (87 in group 1 and 91 in group 2) and range of motion (84 degrees in group 1 and 90 degrees in group 2) were the same in both groups. Conclusion: In this group of patients with RA the survival of the Kudo type 5 TEP with cemented ulnar component is better as compared to the uncemented ulnar component

We report an artificial elbow joint with a novel type radial component that we have designed that is now at the stage of trial production. The humeral component is a trochlea capitulum replacement type with a stem. The ulnar component with a stem has an articular surface distributed not only on the trochlea surface but also on the capitulum surface of the humeral component, and has another concave articular surface toward the radial component. The radial component also has a stem and has a spherical convex articular surface. This surface of the radial component does not assume the conventional anatomical morphology, but the convexity is designed to fit the concave articular surface of the ulnar component. In other words, the new artificial elbow joint is a functionally dissociated type, in which flexion-extension is achieved by the humeroulnar joint while rotation is done via the radioulnar joint. The newly designed artificial joint was used to replace the cadaveric elbow joint. Radiographic studies were conducted to observe the compatibility of each component during extension-flexion and rotationmovements. By replacing the cadaveric elbow joint with the newly designed artificial elbow joint and performing manual extension-flexion simultaneous with pronation-supination, the flexion positions of the humeral component and ulnar component were not affected, and stable compatibility was obtained for the radial component and ulnar component. Artificial elbow joints with a radial component have been reported by various authors. However, since the humeroradial joint possesses two movement axes for both flexion-extension and rotation, good compatibility with the humeroulnar joint is necessary. Aradial component that simply adopts the anatomical morphology does no tachieve good humeroradial joint compatibility. The functionally dissociated artificial elbow joint that we have designed is expected to offer a clue to solve these problems

A 55-year-old woman who was diagnosed as RA (stage, class ) in 1995 had undergone right total elbow arthroplasty (TEA) in October 2006. We implanted her prosthesis FINE ELBOW. ®. (Nakashima Medical, Japan). Prosthesis of the humerus side is made of Co-Cr-Mo, and the ulna side is of polyethylene. Radius side is metal back system which inserts a polyethylene joint part in metal holder made by Co-Cr-Mo. All components were fixed by cement. She complained her right elbow uncomfortable gradually from January 2008. X-ray radiograph showed loosening of the ulnar component. So we performed revision surgery using ulnar revision sack in May 2008. This ulnar component had only a product made in polyethylene and we inserted the component of the product made in the polyethylene in a metal sack. The operation was successed and now she does housework. We think that strength is not worthy of the ulnar component made by polyethylene in TEA for the patient with terrible joint destruction and high daily activity patient of rheumatoid arthritis

To measure any observed migration and rotation of humeral and ulnar components using radiostereometric analysis. From 2002–2004 in a prospective ongoing study, twelve elbows in patients treated with either a linked or unlinked Acclaim total elbow prosthesis were included in a radiostereometry study. Six tantalum markers were introduced into the humerus another three markers were located on a humeral component. Four markers were placed in to ulna and three markers located on the ulnar component. RSA radiographs were taken postoperatively, six, twelve and twenty-four months. The radiographs were digitised and analysed using UmRSA software. The relative movement of the humeral and ulnar implants with respect to the bone was measured. At twelve months, the largest segment translation of the humeral component was in the anterior/posterior direction with a mean of 0.44mm followed by medial/lateral translation of 0.39 mm; there was minimal proximal/ distal translation or with a mean of 0.16mm. Paired t-tests between twelve and 24 months segment translation data showed the mean differences to be no more than 0.056mm. The largest rotation at twelve months was anteversion/retroversion with a mean of 2.40deg, anterior tilt had a mean of 1.20deg and varus/valgus tilt was minimal mean 0.60deg. Mean difference between twelve and 24 months segment rotation was no more than 0.30deg. In contrast, humeral tip motion produced a mean of 1.1mm at 12 months dominated by movement in the plane horizontal plane with a mean difference at 24 months of 0.06mm. No patients could be measured for segment micromotion of the ulnar component due to technical difficulty in visualising tantalum markers in the ulna. Early micromotion of the Acclaim humeral implant occurs mostly by rotation about the vertical axis accompanied by anterior tilt. This motion reaches a plateau at 12 months after operation

Introduction: The design of the GSB III elbow arthroplasty has essentially remained unchanged since 1978 until recently. Because of observations of aseptic loosening of the ulnar component, the ulnar stem was changed in an excentric curved shape. The aim of the present study was to assess the clinical and radiographic outcome after more than 2 years of follow up with the new ulnar stem shape. Patients and methods: Between january 2000 and august 2002, 34 patients had undergone 36 total elbow replacements with the GSB III device with a new curved ulnar shape. Nineteen patients (20 elbows) underwent the operation for the first elbow arthroplasty and 16 patients underwent revision surgery. The mean follow up was 35 months (R: 25–49). The subjective satisfaction and pain intensity were assessed. Clinical exam recorded range of motion and strength. Radiographs were analysed for implant loosening and osteolysis. Results: There was a significant improvement of the average range of motion in flexion-extension from pre-operative 82degree to postoperative 105degree for all 36 elbows (t-test, p< 0,005). The 20 cases with primary elbow arthroplasty showed a significant improvement in the average range of flexion-extension from 76degree to 106degree (t-test, p< 0,001). The subjective assessment for satisfaction averaged 93 per cent at the time of follow up. For the 16 patients with revision elbow arthroplasty, the average range of flexion-extension improved from 90degree to 103degree (p< 0,01). The mean subjective satisfaction rated at 94 per cent. One case showed a radiolucent line at the ulnar component which remained unchanged at follow up. There was no component loosening. Discussion: The new excentric curved ulnar component shows no case of component loosening in our series for primary and revision elbow arthroplasty after 2 years. The range of motion and patient satisfaction are promising

For the last few decades there have been several successful reports of TEA of both semi-constrained and non-linked prosthesis: pain relief, improvement of range of motion, functional improvement, and good survival rate of the components. However, other reports also showed that TEA had higher complication rates and lower survival rate than knee and hip joint replacement. To solve this problem some in vitro kinematic studies about TEA have been done and reported. But in vivo research has not been reported yet in the TEA, and it must be done for an essential solution. The aim of this study is to analyze in vivo motion of TEA components using two- to three- (2D/3D) registration technique. Six patients, six elbows were included in this study, having been treated with K-Elbow because of rheumatoid arthritis. The mean age at the operation was 47.2 years The mean duration between the operation and the fluoroscopic surveillance was 56.7 months. Under fluoroscopic examination in the sagittal plane, each patient was asked to bend his or her elbow from full extension to full flexion. Successive elbow motions were recorded as serial digital X-ray images using a digital image intensifier system. In vivo 3D poses of the humeral and the ulnar components were estimated using a 2D/3D registration technique, which uses CAD models to reproduce spatial postures of the humeral and the ulnar components from calibrated single view fluoroscopic images. The algorithm utilizes a feature-based approach to minimize distances between lines drawn from a contour found in the 2D image to the X-ray source and a surface CAD model with iterative computations. The amount of extension/flexion, varus/ valgus, and internal/external rotation angles of the ulnar component for the humeral component were evaluated quantitatively using Euler’s method. Results: The minimum flexion angle between the components was 33.6°± 18.5. Four of the six elbows exhibited inimum flexions of > 30° and the other two elbows exhibited < 30°. One elbow exhibited excessive flexion contracture > 50°. The maximum flexion angle was 126.7° ± 5.5. Only one elbow demonstrated flexion angle < 120° and all the others > 120°. The arc of range of motion was 93.0°±19.4. Concerning the valgus/varus angles between the components, there was a variation among patients. And from 30 to 120° flexion, there was a tendency to incline valgus with the increase of flexion. The mean valgus angle through flexion was −0.1°± 4.3 and the magnitude of displacement of valgus angle was 9.5° ± 4.0. In a similar way, there was a variation among patients about the rotation between the components. And from 30 to 120° flexion, there was a tendency to incline external rotation with the increase of flexion. The mean internal rotation through flexion was −1.0° ± 4.3 and the magnitude of displacement of internal rotation was 8.1°± 3.3

Introduction. Total Elbow Arthroplasty (TEA) is recognized as an effective treatment solution for patients with rheumatoid arthritis or for traumatic conditions. Current total elbow devices can be divided into linked or unlinked design. The first design usually presents a linking element (i.e. an axle) to link together the ulnar and humeral components to stabilize the joint; the second one does not present any linkage and the stability is provided by both intrinsic design constraints and the soft tissues. Convertible modular solutions allow for an intraoperative decision to link or unlink the prosthesis; the modular connections introduce however additional risks in terms of both mechanical strength and potential fatigue and fretting phenomena that may arise not only due to low demand activities loads, but also high demand (HD) ones that could be even more detrimental. The aim of this study was to assess the strength of the modular connection between the axle and the ulnar component in a novel convertible elbow prosthesis design under simulated HD and activities of daily living (ADLs) loading. Methods. A novel convertible total elbow prosthesis (LimaCorporate, IT) comprising both ulnar and humeral components that can be linked together by means of an axle, was used. Both typical ADLs and HD torques to be applied to the axle were determined based on finite element analysis (FEA); the boundary load conditions for the FEA were determined based on kinematics analysis on real patients in previous studies. The FEA resultant moment acting on the axle junction during typical ADLs (i.e. feeding with 7.2lbs weight in hand) was 3.2Nm while for HD loads (i.e. sit to stand) was 5.7 Nm. In the experimental setup, 5 axle specimens coupled with 5 ulnar bodies through a tapered connection (5 Nm assembly torque) were fixed to a torque actuator (MTS Bionix) and submerged in a saline solution (9g/l). A moment of 3.2 Nm was applied to the axle for 5M cycles through a fixture to test it under ADLs loading. After 5M cycles, the axles were analyzed with regards to fretting behavior and then re-assembled to test them against HD loading by applying 5.7 Nm for 200K cycles (corresponding to 20 years function). Results. All 5 samples withstood all 5.2M loading cycles without any mechanical failure. At the end of 5M cycles, each axle was still stable as the measured disassembly torque was 3.96 +/−0.18 Nm. Slight signs of fretting were detected on the tapered connection after 5M cycles, however they did not compromise the mechanical connection nor the stability. Discussion and Conclusions. Currently there are no reference standards that properly define protocols for biomechanical testing of elbow prostheses. In the present study, a test to mechanically assess the strength of an axle connection under both typical ADLs and HD loads was set. The connection was able to withstand the imposed conditions. In general, testing of TEA devices should include not only standard ADLs loads but also HD loads, which could be more detrimental for the long-term survivorship. For any figures or tables, please contact authors directly

Introduction. The interaction between the mobile components of total elbow replacements (TER) provides additional constraint to the elbow motion. Semi-constrained TER depend on a mechanical linkage to avoid dislocation and have greater constraint than unconstrained TER that rely primarily in soft tissue for joint stability. Greater constraint increases the load transfer to the implant interfaces and the stresses in the polyethylene components. Both of these phenomena are detrimental to the longevity of TER, as they may result in implant loosening and increased damage to the polyethylene components, respectively[1]. The objective of this work was to compare the constraint profile in varus-valgus and internal-external rotation and the polyethylene stresses under loads from a common daily activity between two semi-constrained TER, Coonrad/Morrey (Zimmer-Biomet) and Discovery® (DJO), and an unconstrained TER, TEMA (LimaCorporate). Methods. We developed finite element (FE) models of the three TER mechanisms. To reduce computational cost, we did not include the humeral and ulnar stems. Materials were linear-elastic for the metallic components (E. Ti6Al4V. =114.3 GPa, E. CoCr. =210 GPa, v=0.33) and linear elastic-plastic for the polyethylene components (E=618 MPa, v=0.46; S. Y. =22 MPa; S. U. =230.6 MPa; ε. U. =1.5 mm/mm). The models were meshed with linear tetrahedral elements of sizes 0.4–0.6 mm. We assumed a friction coefficient of 0.02 between metal and polyethylene. In all simulations, the ulnar component was fixed and the humeral component loaded. We computed the constraint profiles in full extension by simulating each mechanism from 8° varus to 8° valgus and from 8° internal to 8° external rotation. All other degrees-of-freedom except for flexion extension were unconstrained. Then, we identified the instant during feeding that generated the highest moments at the elbow[2], and we applied the joint forces and moments to each TER to evaluate the stresses in the polyethylene. To validate the FE results, we experimentally evaluated the constraint of the design with highest polyethylene stresses in pure internal-external rotation and compared the results against those from a FE model that reproduced the experimental setup (Fig.1-a). Results. For each design, the constraint profiles in varus-valgus (Fig.2-a) were similar to internal-external rotation (Fig.2-b). All designs showed a lax zone in which the mechanisms rotated freely and an engagement zone in which the mobile components contacted, resulting in load transfer. The laxity of the Coonrad/Morrey and the Discovery® was similar and lower than that of the TEMA. After engagement, the stiffness of the TEMA was less than that of the Discovery® and the Coonrad/Morrey. The TEMA showed the lowest polyethylene stresses of all three designs under demanding loads during feeding. Only Discovery® and Coonrad/Morrey had zones reaching permanent deformation (Fig.3). For the Coonrad/Morrey, with the highest polyethylene stresses, the experimental and computational constraint profiles were similar (Fig.1-b). Discussion. The TEMA unconstrained design transferred less moment than semi-constrained designs, reducing the burden on the implant interfaces. Moreover, the TEMA design had lower stresses in the polyethylene components due to the combination of less constraint and a lack of sharp edges on the articular surfaces. For any figures or tables, please contact the authors directly

Purpose of the study: to demonstrate a mechanism of loosening of the Souter-Strathclyde Total Elbow Replacement (TER) using evidence from revision surgery. Methods: nine Souter-Strathclyde humeral and ulnar components retrieved from revision surgery for aseptic loosening were examined macroscopically and then microscopically under low power magnification. The wear patterns were compared and photographed. Results and conclusion: inspection of the retrieved cobalt chrome steel humeral components revealed no evidence of surface wear. However on examination of the polyethylene ulnar components six of the nine exhibited macroscopic wear taking the form of deep linear grooves on either the medial or lateral articulating surface. Microscopic examination revealed wear exhibited as complete disruption of the polyethylene machining lines on the medial and lateral articular surfaces, but almost complete preservation on the central gliding ridge. The findings are best explained in the context of normal elbow kinematics and congruence of the Souter-Strathclyde components. The normal elbow joint is not a simple hinge joint. In addition to flexion/extension, axial rotation and abduction/adduction motion patterns occur. However articulating surfaces of the Souter-Strathclyde components are highly congruent and thus resist the elbow’s normal translational and rotational movements. Our wear patterns are the result of humeral component rocking during flexion and extension as a result of this resistance. The central gliding ridge is preserved because the humeral component is not always in contact with it as it rocks out of its articulation in the coronal plane. Furthermore as the humeral component rocks, the sharp edge of its articulating surface makes contact with the articulating surface of the ulna causing abrasion and in the extreme circumstance the deep linear grooves observed. The biomechanics eventually lead to component loosening

Purpose: To measure any observed migration and rotation of humeral and ulnar components using radiostereometric analysis. Methods: From 2002–2004 in a prospective study, twelve elbows in patients treated with either a linked(3) or unlinked(9) Acclaim total elbow prosthesis were included in a radiostereometry study. Six tantalum markers were introduced into the humerus another 3 markers were located on a humeral component. Four markers were placed in to ulna and three markers located on the ulnar component. RSA radiographs were taken postoperatively, six, twelve and twenty-four months. The radiographs were digitised and analysed using UmRSA software. The relative movement of the humeral and ulnar implants with respect to the bone was measured. Results: At twelve months, the largest rotation of the humeral component was anteversion/retroversion with a mean of 20, anterior tilt had a mean of 1.10 and varus/valgus tilt was minimal mean 0.60. Mean difference between twelve and 24 months segment rotation was no more than 0.50. Rotation in unlinked humeral implants reached a plateau at 12 months this did not occur in linked implants. Paired t-tests between twelve and 24 months segment translation data showed the mean differences to be no more than 0.04mm. In contrast, humeral tip motion produced a mean of 1.3mm at 12 months dominated by movement in the horizontal plane with a mean difference at 24 months of 0.2mm. Mean micro-motion of the ulna implant tip was 0.32mm at 12 months with a mean difference at 24 months of 0.1mm. Conclusions: Early micromotion of the Acclaim humeral implant occurs mostly by rotation about the vertical axis accompanied by anterior tilt. In unlinked implants this motion reaches a plateau at 12 months after operation but does occur in linked implants

The purpose of this study was to evaluate the outcomes of treatment of rheumatoid elbows with Kudo Total Elbow Replacements. Between 1993–1997 we performed 39 Kudo Total Elbow Replacements in 35 patients with Rheumatoid Arthritis, aged 39–81 years old (mean age: 60,7 yrs). Eleven patients (13 elbows) were male and 24 (26 elbows) were female. Twenty-eight (28) replacements were performed on the right side and eleven (11) on the left. All the patients were evaluated clinically (pre-op and post-op, using Mayo score system) and radiographically. In seven elbows another procedure (radial head excision (three), radial head excision & synovectomy (three), arthroscopy & interposition arthroplasty(one)) had been performed previously for the rheumatoid arthritis. Eight elbows seemed to have ulnar nerve problems pre-op. We followed-up 31 patients (35 elbows). Mean follow-up was 5years (range: 4–8 years). The pre-operative pain had been reduced significantly in almost all patients. In the majority, the movement had also been improved post-operatively. Two elbows were unstable (one subluxated, one dislocated). Both presented early postoperatively. Only one patient developed a postoperative ulnar nerve problem and that resolved. One elbow had a delay in wound healing. Radiolucency appeared around both the humeral and ulnar components in five elbows, around humeral component in two and around ulnar component also in two. Five elbow replacements were revised. Four of them due to aseptic loosening and one due to instability problem (dislocation). No deep infection was noticed in any elbow. In our hands, Kudo Elbow Replacements seemed to have aseptic loosening rates comparable to other series and low dislocation rates

Aims

The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry.

Objective: To investigate the long-term follow-up results of total elbow arthroplasty (TEA) with a non-constrained elbow prosthesis with a solid ceramic trochlea (Stemmed Kyocera type I, SKC-I) on patients who have rheumatoid arthritis (RA). Materials and Methods: Between May 1988 and February 1999, 84 patients of RA underwent TEA with cement fixation (108 elbows). Fourteen patients (14 elbows) were lost due to change of address. One patient (1 elbow) required revision surgery due to aseptic loosening, and 2 elbow implants in 2 individuals were removed due to deep infection, and 18 patients (24 elbows) have died within 5 years after the surgery due to causes unrelated to TEA. Of the remaining 52 patients (70 elbows), 38 patients (53 elbows, 75.7%) were available for the over-5-year detailed clinical and radiographic review at a mean period of 9.2 years (range, 5–17 years). The clinical condition of each elbow before and after operation was assessed according to the Japanese Orthopaedic Association (JOA) elbow scoring system (up to 100 points). Results: The average postoperative JOA score improved from 45.1 to 83.3 points with marked pain relief in all but 2 cases. The mean range of motion (ROM) of extension / flexion before the surgery was −35.6 / 117.1 and at last follow-up was −17.6 / 136.9 degrees. The mean ROM of pronation / supination improved from 49.6 / 55.8 to 80.0 / 82.1 degrees. Revision surgery was required in 2 patients (2 elbows) due to humeral fracture and ulnar component fracture, respectively. One elbow implant was removed due to deep infection. An ulnar component was removed from one patient with olecranon fracture. During the follow-up, 3 elbow joints had dislocated in 3 patients, and loosening was seen in 5 elbows in 5 patients. Of the 53 elbows, 45 elbows (84.9 %) were judged to have excellent (90–100) or good (75–89) results, and 2 elbows to have poor (< 60) results (0.04%). With loosening and revision or removal of the implant defined as the end point, the likelihood of survival of the prosthesis was 92.2 and 88.3%, respectively, for as long as 10 years by Kaplan-Meier analysis. Conclusion: The results of the current study showed a high reliability over a long period of the SKC-I when implanted with cement. However, good results in the use of non-constrained devices are limited by the amount of bone and by the need for the ligamentous stability, which can be problematic in RA cases

Aims

The aim of this study was to review the provision of total elbow arthroplasties (TEAs) in England, including the incidence, the characteristics of the patients and the service providers, the types of implant, and the outcomes.

Aims

There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA).

In rheumatoid arthritis (RA), non constrained or semi-constrained prostheses can be used. The authors used the Kudo III, IV or V or iBP prostheses 54 times from 1994 to 2003. After initial satisfactory results, they had to change one or both implants for several reasons: humeral stem fracture (5 cases), unipolar humeral loosening (1 case), ulnar loosening without laxity (8 cases), polyethylene wear (11 cases), due to progressive ulnar collateral ligament lengthening and progressive valgus deformity, without or with metallosis, due to contact between Cr-Co humeral component and titanium alloy ulnar component, chronic infection (1 case). When the local conditions were satisfactory (bone stock, ligament balance), the fractured or loosened component was changed. When the conditions were bad (poor bone stock, ligament misbalance, metallosis), both implants were removed; posterior humeral and/or medial or lateral ulnar window were used to removed the uncemented stems still osteointegrated. All the bipolar operations used the Coonrad-Morrey prosthesis, but the last case a Discovery prosthesis. The operative tricks are described, the management of the extensor apparatus is discussed, the clinical outcomes (especially the extensor apparatus function, most often weak) and the radiographic outcomes are presented

Purpose of study:. Total elbow replacement (TER) is one of the surgical options for treatment of severe haemophilic arthropathy of the elbow. There are only a few small series described in the literature. The goal of our study was to evaluate our cases and add these data to the known literature. Methods:. A retrospective analysis of a series of 8 TER's (5 patients) was performed. Patients were seen in clinic and evaluated by physical examination, a VAS score for pain, the Mayo Elbow Performance Score (MEPS, 100 points=excellent) and X-rays of the affected elbow. Mean follow-up was 91 (4–236) months, and 103 months when we excluded a patient with only 4 months follow-up. Primary diagnosis was Hemophilia type A in 4 and von Willebrand disease in 1 patient. 2 patients were positive for Hepatitis C and 3 for HIV. Mean age at primary surgery was 46.7 (31.8–63.1) years. Results:. The mean VAS score for pain improved from 7.9 to 0.5 and the mean Mayo Elbow Performance Score from 36 to 93. The arc for flexion/extension improved from 68° to 91° and from to 75° to 153° for pro- and supination. Revision surgery was performed in 3 out of 8 TER's; 1 because of loosening of the humeral component (18.7 years postop), 1 for loosening of the ulnar component (9.9 years postoperatively) and 1 due to a late deep infection, 4 years postoperatively. The last case was treated with an excision arthroplasty, the others with a revision. No replacement currently shows signs of loosening. Conclusion:. This is a small retrospective study, as are the other studies on TER in haemophilic patients. It demonstrated excellent clinical outcome and an acceptable survival rate of a TER, with a mean follow-up of 7.6 years even in this young patient population