Clin Orthop Surg.  2019 Dec;11(4):369-379. 10.4055/cios.2019.11.4.369.

Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery

• Kwak JM
• Koh KH
• Jeon IH

• KMID: 2462529
• DOI: http://doi.org/10.4055/cios.2019.11.4.369

Abstract

Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients. Total elbow prostheses have evolved over the years and now include the linked, unlinked, and convertible types. However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Here, we introduce each type of implant and evaluate clinical outcomes and complications by reviewing the previous literature.

Keyword

Arthroplasty; Replacement; Elbow; Complications; Reoperation; Treatment outcome

MeSH Terms

Aged
Arthritis
Arthritis, Rheumatoid
Arthroplasty*
Elbow Prosthesis
Elbow*
Humans
Osteoarthritis
Periprosthetic Fractures
Reoperation
Treatment Outcome

Figure

• 

  Fig. 1 Transmission of nonanatomic force results in stress shielding at the humeral condyles and olecranon, leading to bone resorption (arrows).

• 

  Fig. 2 Osteoporotic periprosthetic fracture due to a fall injury after unlinked total elbow arthroplasty.

• 

  Fig. 3 (A, B) Strut graft augmentation is typically required after nonviable bone extraction. The graft must be long enough to span the fracture site and allow sufficient fixation of both the proximal and distal fragments. Cancellous bone from the humeral head allograft can be morselized for later use.

• 

  Fig. 4 First stage of revision surgery. (A) Chronic deep infection. Partial absoprtion of the distal humerus and proximal ulna, caused by chronic infection and polyethylene wear. (B) Implant removal and insertion of an antibiotic cement spacer. The fracture occurred during removal of the cement (arrows).

• 

  Fig. 5 Second stage of revision surgery using allograft-prosthetic composite (APC). (A) Modified type I APC used to manage bone defects. (B) Plain radiographs at the final follow-up. Bone union was observed between the host bone and the allograft bone.

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