Skip to main content

Advertisement

SpringerLink
Log in

Primary total elbow arthroplasty

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow.

Materials and Methods

We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis.

Results

In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced.

Conclusion

Elbow arthroplasty remains a valuable option for deformed and ankylosed elbows especially in the demanding patients with crippling deformity of the elbow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 1981;63:872–7.

    Article  CAS  PubMed  Google Scholar 

  2. Morrey BF. Applied anatomy and biomechanics of the elbow joint. Instr Course Lect 1986;35:59–68.

    CAS  PubMed  Google Scholar 

  3. Govind P, Yogesh P. Total elbow replacement: Baksi sloppy Hinge joint. Jivisha 2011.

    Google Scholar 

  4. Morrey BF. Complications of elbow replacement surgery. The Elbow and its disorders. 3rd ed, Philadelphia: WB Saunders Company; 2000. p. 667–72.

    Google Scholar 

  5. Wright TW, Wong AM, Jaffe R. Functional outcome comparison of semi constrained and unconstrained total elbow arthoplaties. J Shoulder Elbow Surg 2000;9:524–31.

    Article  CAS  PubMed  Google Scholar 

  6. Chafik D, Lee TQ, Gupta R. Total elbow arthroplasty: Current indications, factors affecting outcomes and followup results. Am J orthop. 2004;33:496–503.

    PubMed  Google Scholar 

  7. Little CP, Graham AJ, Carr AJ. Total elbow arthroplasty: Systematic review of the literature in English language until the end of 2003. J Bone Joint Surg Br 2005;87:437–44.

    Article  CAS  PubMed  Google Scholar 

  8. Gill DR, Morrey BF. The Coonrad-Morrey total elbow arthoplasty in patients who have rheumatoid arthritis: A ten to fifteen year followup study. J Bone Joint Surg Am 1998;80:1327–35.

    Article  CAS  PubMed  Google Scholar 

  9. Kraay MJ, Figgie MP, Inglis AE, Wolfe SW, Ranawat CS. Primary semi constrained total elbow arthroplasty: Survival analysis of 113 consecutive cases. J Bône Joint Surg Br 1994;76:636–40.

    Article  CAS  PubMed  Google Scholar 

  10. Little CP, Graham AJ, Karatzas G, Woods DA, Carr AJ. Outcome of total elbow arthoplasty for rheumatoid arthritis: Comparative study of 3 implants. J Bone Joint Surg Am 2005;87:2439–48.

    PubMed  Google Scholar 

  11. Mansat P, Morrey BF. Semi constrained total elbow arthroplasty for ankylosed and stiff elbows. J Bone Joint Surg Am 2000;82:1260–8.

    Article  CAS  PubMed  Google Scholar 

  12. Figgie MP, Inglis AE, Mow CS, Figgie HE 3rd. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg Am 1989;71:513–20.

  13. Bernhard J, Robert A, Moorey BF. Management of acute distal humeral fractures in patients with rheumatoid arthritis: A case Series. J Bone Joint Surg Am 2008:90:2197–205.

    Article  Google Scholar 

  14. Larson AN, Morrey BE. Interposition arthroplasty with an Achilles tendon allograft as a salvage procedure for the elbow. J Bone Joint Surg Am 2008;90;2714–23.

    Article  PubMed  Google Scholar 

  15. Bryce CD, Armstrong AD. Anatomy and biomechanics of elbow. Orthop Clin North Am 2008;39:141–54.

    Article  PubMed  Google Scholar 

  16. Prasad A, Robertson DD, Sharma GB, Stone DA. Elbow: The trochleogingylomoid joint. Semin Musculoskelet Radiol 2003;7:19–24.

    Article  PubMed  Google Scholar 

  17. Boone DC, Azen SP. Normal range of motion of joints in male subjects. J Bone Joint Surg Am 1979;61:756–9.

    Article  CAS  PubMed  Google Scholar 

  18. Morrey BF, Chao EY. Passive motion of the elbow joint. J Bone Joint Surg Am 1976;58:501–8.

    Article  CAS  PubMed  Google Scholar 

  19. Kapandji A. Biomechanics of pronation and supination of the forearm. Hand Clin 2001;17:111–22, vii.

    CAS  PubMed  Google Scholar 

  20. Van der Lugt JC, Geskus RB, Rozing PM. Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. J Bone Joint Surg Am 2004;86:465–73.

    Article  PubMed  Google Scholar 

  21. Schmidt K, Hilker A, Miehlke RK. Differences in elbow replacement in rheumatoid arthritis. Orthopade 2007;36:714–22.

    Article  CAS  PubMed  Google Scholar 

  22. Obremskey WT, Bhandari M, Dirschl DR, Shemitsch E. Internal fixation versus arthroplasty of comminuted fractures of the distal humerus (review). J Orthop Trauma 2003;17:463–5.

    Article  PubMed  Google Scholar 

  23. Whitcomb PJ, Kenneth JF, George SA. Distal humerus fractures. Orthop Clin North Am 2008;39:187–200.

    Article  Google Scholar 

  24. Robert BD, George B. Mercer’s orthopaedics surgery. In: John RS, Aresh HN, editors. The shoulder and elbow joints. 9th ed. Volume 2, Delhi. Revised and updated by Anil K. Dhal. Delhi: Jaypee Brothers; 1996. p. 1015–69.

    Google Scholar 

  25. O’Driscoll SW, An KN, Korinek S, Morrey BF. Kinematics of semi-constrained total elbow arthroplasty. J Bone Joint Surg Am 1992:74:297–99.

    Article  Google Scholar 

  26. Schneeberger AG, Adams R, Morrey BF. Semiconstrined total elbow replacement for the treatment of posttraumatic osteoarthrosis. J Bone Joint Surg Am 1997;79:1211–22.

    Article  CAS  PubMed  Google Scholar 

  27. Celli A, Morrey B. Total elbow arthroplsty in patients forty years of age or less. J Bone Joint Surg Am 2009:91:1414–8.

    Article  PubMed  Google Scholar 

  28. Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King DJ. Functional outcome of semiconstrined total elbow arthroplasty. J Bone Joint Surg Am 2000;82:1379–86.

    Article  CAS  PubMed  Google Scholar 

  29. Morrey BF, Adams RA. Semi-constrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 1992;74:479–90.

    Article  CAS  PubMed  Google Scholar 

  30. Kozak TK, Adams RA, Morrey BF. Total elbow arthroplasty in primary osteoarthritis of the elbow. J Arthroplasty 1998;13:837–42.

    Article  CAS  PubMed  Google Scholar 

  31. Tanaka N, Kudo H, Iwano K, Sakahashi H, Sato E, Ishii S. Kudo total elbow arthroplasty in patients with rheumatoid arthritis: A long term followup study. J Bone Joint Surg Am 2001;83:1506–13.

    Article  CAS  PubMed  Google Scholar 

  32. Ross AC, Sneath RS, Scales JT. Endoprosthetic replacement of the humerus and elbow joint. J Bone Surg Br 1987;69:652–5.

    Article  CAS  Google Scholar 

  33. Kulkarni A, Florenza F, Grimer RJ, Carter SR, Tillman RM. The results of endoprosthetic replacement for tumors of distal humerus. J Bone Joint Surg Br 2003;85:240–3.

    Article  CAS  PubMed  Google Scholar 

  34. Sperling JW, Pritchard DJ, Morrey BF. Total elbow arthroplasty after resection of tumors at the elbow. Clin Orthop Relat Res 1999;367:256–61.

    Article  Google Scholar 

  35. Jupiter JB. The management of nonunion and malunion of distal humerus: A 30 year experience. J Orthop Trauma 2008;22:742–50.

    Article  PubMed  Google Scholar 

  36. Ring D, Gulotta L, Jupiter JB. Unstable nonunion of the distal part of the humerus. J Bone Joint Surg Am 2003;85:1040–6.

    Article  PubMed  Google Scholar 

  37. Helfet DL, Kloen P, Anand N, Rosen HS. Open reduction and internal fixation of delayed union and nonunion of fractures of the distal part of the humerus. J Bone Joint Surg Am 2003;85:33–40.

    Article  PubMed  Google Scholar 

  38. Cli A, Veillette CJ, Sanchez-Sotelo J, Morrey BF. Linked elbow replacement: A salvage procedure for distal humeral nonunion. J Bone Joint Surg Am 2008; 85:1939–50.

    Google Scholar 

  39. Morrey BF, Adams RA. Semi constrained elbow replacement for distal humeral nonunion. J Bone Joint Surg Am 1995;77:67–72.

    Article  CAS  Google Scholar 

  40. Garrett JC, Ewald FC, Thomas WH, Sledge CB. Loosening associated with G.S.B. hinge total elbow replacement in patients with rheumatoid arthritis. Clin Orthop Relat Res 1977:127:170–4.

    Google Scholar 

  41. Szekeres M, King GJ. Total elbow arthroplasty. J Hand Ther 2006;19:245–53.

    Article  PubMed  Google Scholar 

  42. Baksi DP. Sloppy hinge prosthetic elbow replacement for posttraumatic ankylosis or instability. J Bone Joint Surg Br 1998;80:614–1619.

    Article  CAS  PubMed  Google Scholar 

  43. King MJ. New frontiers in elbow reconstruction: Total elbow arthroplasty. Instr Course Lect 2002;51:43–51.

    PubMed  Google Scholar 

  44. Angst F, John M, Pap G, Mannion AF, Herren DB, Flury M, et al. Comprehensive assessment of clinical outcome and quality of life after total elbow arthroplasty. Arthritis Rheum 2005;53:73–82.

    Article  PubMed  Google Scholar 

  45. O’Driscoll SW, King GJ. Treatment of instability after total elbow arthroplasty. Orthop Clin North Am 2001;32:679–95.

    Article  PubMed  Google Scholar 

  46. Goldberg VM, Figgie HE 3rd, Inglis AE, Figgie MP. Total elbow arthroplasty. J Bone Joint Surg Am 1988;70:778–83.

    Article  PubMed  Google Scholar 

  47. Gill DR, Morrey BF, Adams RA. Total elbow arthroplasty in patients with Rheumatoid arthritis. In: Morrey BF, editor. The elbow and its disorder. 3rd ed. Philadelphia: Saunders; 2000. p. 631–9.

    Google Scholar 

  48. Van der Lugt JC, Rozing PM. Outcome of revision surgery for faillyded primary Souter-Strathclyde total elbow prosthesis. J Shoulder Elbow Surg 2006;15:208–14.

    Article  PubMed  Google Scholar 

  49. Shi LL, Zurakowaski D, Jones DG, Koris MJ, Thornhill TS. Semiconstained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Joint Surg Am 2007;89:1467–75.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Maharishi Valmiki Hospital, Pooth Khurd, Delhi, India

    Suresh Kumar & Sunayan Mahanta

Authors
  1. Suresh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunayan Mahanta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suresh Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, S., Mahanta, S. Primary total elbow arthroplasty. IJOO 47, 608–614 (2013). https://doi.org/10.4103/0019-5413.121592

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.121592

Key words

Search

Navigation