Total elbow arthroplasty in primary osteoarthritis of the elbow

doi:10.1016/S0883-5403(98)90041-9

The Journal of Arthroplasty

Volume 13, Issue 7, October 1998, Pages 837-842

https://doi.org/10.1016/S0883-5403(98)90041-9 Get rights and content

Abstract

Primary osteoarthritis of the elbow is an infrequent condition typically managed by some form of debridement. There is no comment in the literature regarding prosthetic replacement for this condition. We report 5 patients (mean age, 68), with a minimum assessment of 3 years (range, 37–125 years) after total elbow arthroplasty. Complications in 4 patients included subluxation, fracture of a humeral component with particulate synovitis, heterotopic ossification, recurrent osteophyte formation, and transient ulnar neuropathy. Although revision was required in 2 of the 5, currently all experience had satisfactory outcomes. While replacement has proven ultimately to be a successful option for this high-demand patient group because of the high complication rate, we do not recommend replacement unless alternate operative options are deemed unacceptable.

References (13)

D Stanley
Prevalence and etiology of symptomatic elbow osteoarthritis
J Shoulder Elbow Surg
(1994)
DA Dennis et al.
Capitello-condylar total elbow arthroplasty for rheumatoid arthritis
J Arthroplasty
(1990)
BF Morrey
Primary degenerative arthritis of the elbow
J Bone Joint Surg [Br]
(1992)
RW Coonrad
Comments on the historical milestones in the development of elbow arthroplasty: indications and complications
Instruct Course Lect AAOS
(1991)
K Tsuge et al.
Debridement arthroplasty for advanced primary osteoarthritis of the elbow
J Bone Joint Surg [Br]
(1994)
FC Ewald et al.
Capitellocondylar total elbow arthroplasty
J Bone Joint Surg [Am]
(1980)

There are more references available in the full text version of this article.

Cited by (89)

Comparison of total elbow arthroplasty complications between various surgical indications at 90-day and 1-year follow-up in 1600 elbows
2023, Journal of Shoulder and Elbow Surgery
Total elbow arthroplasty (TEA) was traditionally a mainstay of treatment for patients with severe inflammatory arthritis. Recently, the indications for TEA have expanded, and TEA has grown into a versatile procedure that can be used to treat several pathologies of the elbow. The objective of this study was to compare complication rates between TEAs performed for rheumatoid arthritis (RA), fracture (FX), or osteoarthritis (degenerative joint disease [DJD]).
A retrospective analysis of the MUExtr data set of the PearlDiver national database was performed. International Classification of Diseases, Tenth Revision codes were used to identify patients who underwent TEA from 2010-2020 and to separate them into RA, FX, and DJD cohorts. Demographic characteristics, comorbidities, and hospital data were identified and compared using analysis of variance. Systemic complications at 90 days and surgical complications at both 90 days and 1 year were compared using multivariable logistic regression. Surgical complications included wound dehiscence, hematoma, deep infection, periprosthetic FX, stiffness, instability, triceps injury, nerve injury, and need for revision.
We identified 1600 patients (DJD, 38.9%; FX, 48.8%; and RA, 12.3%). The majority of patients in all 3 cohorts were female patients, with the RA group having a significantly higher percentage of female patients than the FX and DJD groups (87.3% vs. 81.4% and 76.9%, respectively; P = .003). No significant differences in systemic complications and surgical complications were noted between all 3 groups at 90 days postoperatively. After controlling for patient factors, FX patients were more likely to have elbow stiffness (odds ratio, 1.53; P = .006) and less likely to have a triceps injury (odds ratio, 0.26; P < .001) at 1 year than were RA or DJD patients.
The indications for TEA have expanded over the past 10 years, with nearly half of all cases being performed for FX. At 1 year postoperatively, TEAs performed for FX have a significantly lower rate of triceps injury and higher rate of elbow stiffness than TEAs performed for other indications. This finding is important to consider when preoperatively planning, as well as when discussing expected outcomes with patients prior to surgery, especially with the expanded incidence of TEA for FX being performed over the past decade.
Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock
2023, JSES Reviews, Reports, and Techniques
Severe humeral bone loss in the setting of failed total elbow arthroplasty (TEA) poses a particularly challenging reconstructive problem. The objective of this study was to review the rationale, indications, contraindications, and detailed surgical technique for using an extended anterior deltopectoral approach to perform a revision TEA when substantially long allografts are required in the presence of severely compromised proximal humerus bone stock.
The authors developed this exposure and reconstructive strategy for failed elbow arthroplasties where the remaining segment of proximal humerus is extremely short, which makes adequate plate fixation of an allograft-prosthetic composite (APC) to the native bone extremely challenging. From an anterior deltopectoral approach, it is possible to use dedicated long, precontoured proximal humerus locking plates to maximize fixation in any remaining proximal humerus. This exposure still makes it possible to provide adequate access to the coupling mechanism of the humeral and ulnar components for implantation of a linked elbow arthroplasty. This exposure also allows for adequate judgment of humeral length and rotation.
Crucial steps in the surgery include extending the dissection past the elbow flexion crease such that one can obtain circumferential exposure of the distal humerus. It is also important to couple the humeral and ulnar components prior to committing to the length of the APC. Special attention must be paid to gauge appropriate APC rotation and length for proper soft tissue tension. When performing fixation of the proximal humeral plate, screw purchase must be maximized in both the remaining native proximal humerus and the APC. Compression across the allograft-host interface is paramount for healing to occur.
An extended anterior deltopectoral approach to perform a revision TEA when very long APCs are required is a viable option to restore humeral bone stock and regain humeral stem fixation in the setting of failed TEA with extensive humeral bone loss.
Unexpected high early failure rate of the Nexel total elbow arthroplasty
2022, JSES International
Aseptic loosening, polyethylene wear, and mechanical failure have limited the use of total elbow arthroplasty (TEA) in physically demanding patients. Newer implant designs have been introduced to improve mechanical performance. The purpose of this study was to report the results obtained after implantation of the Nexel TEA.
Over a 3-year period, 2 surgeons implanted a total of 35 consecutive Nexel primary TEAs. The average patient age was 65 years, and standard TEA indications were utilized. Elbows were evaluated for pain, motion, the Mayo Elbow Performance Score, complications, and reoperations.
Twelve elbows underwent a revision surgery with removal of either a part of or all Nexel components at an average of 2.2 years. All revision surgeries performed at our institution revealed gross loosening of the component(s). Metallic debris and periprosthetic fractures were present in 45% and 50% of cases, respectively. Radiographic evaluation of existing components revealed humeral component loosening and periprosthetic fractures in 2 and 4 elbows, respectively. Overall, 17 of 35 (50%) elbows underwent reoperation, and 20 of 35 (60%) elbows sustained at least 1 postoperative complication.
Primary TEA with implantation of this implant was associated with an unacceptably high rate of early implant loosening, periprosthetic fracture, and reoperation. We hypothesize that this early unexpected mechanical failure could be explained by both the utilization of a titanium-on-polyethylene bearing surface and a more posterior center of rotation causing premature anterior impingement with flexion leading to failure of the bonding interface, secondary titanium particle shedding, polyethylene wear, and osteolysis.
Surgical management of osteoarthritis in the shoulder and elbow
2022, Journal of Hand Therapy
Interesting recent trends are apparent in the setting of shoulder and elbow pathology. There is an increase in utilization of shoulder arthroplasty for osteoarthritis and post traumatic arthritis. At the same time, there remain limited options for osteoarthritis of the elbow particularly in the young and or active patient. This manuscript details surgical options for osteoarthritis at the elbow and shoulder.
The ulnohumeral arthroplasty: technical tips for safely managing the brachial artery
2021, JSES Reviews, Reports, and Techniques
One surgical option to manage idiopathic osteoarthritis of the elbow is an ulnohumeral arthroplasty. A potential complication to avoid during this procedure is inadvertent over penetration of the anterior cortex of the humerus. If this occurs, injury to the median nerve and brachial artery is possible as these structures may lie within 7 mm of the anterior humerus. This surgical technique describes technical tips in regards to patient positioning and specific instrument usage that serve to diminish the risk of this catastrophic complication occurring by allowing these critical neurovascular structures to fall away from the anterior humerus.
Primary Elbow Osteoarthritis: Evaluation and Management
2021, Journal of Clinical Orthopaedics and Trauma
Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity
. Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages
. When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures
. The ulnar nerve needs to be carefully assessed and addressed at the time of surgery
. Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice
. Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.

View all citing articles on Scopus

View full text

Case reportTotal elbow arthroplasty in primary osteoarthritis of the elbow

Abstract

J Shoulder Elbow Surg

J Arthroplasty

Primary degenerative arthritis of the elbow

J Bone Joint Surg [Br]

Comments on the historical milestones in the development of elbow arthroplasty: indications and complications

Instruct Course Lect AAOS

Debridement arthroplasty for advanced primary osteoarthritis of the elbow

J Bone Joint Surg [Br]

Capitellocondylar total elbow arthroplasty

J Bone Joint Surg [Am]

Case report
Total elbow arthroplasty in primary osteoarthritis of the elbow