Arch Hand Microsurg.  2023 Dec;28(4):211-225. 10.12790/ahm.23.0024.

Complications of total elbow arthroplasty

• Cha SM
• Ga IH
• Kim YH
• Shin HD

• KMID: 2548592
• DOI: http://doi.org/10.12790/ahm.23.0024

Abstract

The indications for total elbow arthroplasty have been expanded beyond severe arthritis to include acute comminuted fractures. Advances in implant manufacturing and surgical techniques in recent decades have led to increasingly better results. Semiconstrained implants are most commonly used, followed by conversion-type and unlinked implants. However, the results are still worse than those of arthroplasty in the knee or hip joint, and various complications such as aseptic loosening, infection, bushing wear, and periprosthetic fractures still occur. As aging adults are increasingly indicated for surgery, we inevitably face complications that are not easy to control. In this review, we discuss intraoperative and late complications, their prevention, and treatment options.

Keyword

Elbow; Total arthroplasty; Complication; Revision surgery

Figure

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  Fig. 1. Fenestration of the ulnar cortex. Reinsertion was impossible due to cement consolidation.

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  Fig. 2. The medial condyle was broken during implant insertion. Overall stability was maintained; thus, further procedures were not needed (triceps preservation approach, type I).

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  Fig. 3. (A) The medial condyle was broken during the insertion of the implant. The overall stability was not good; thus, wiring was added. (B) At the 2-year follow-up, radiographic bony union was confirmed, with no loosening (type I).

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  Fig. 4. (A) The dorsal cortex of the ulna was broken during revision arthroplasty with a long stem (type II). (B) At the 1-year follow-up, stem stability is maintained.

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  Fig. 5. Mayo classification of periprosthetic fractures after elbow arthroplasty.

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  Fig. 6. (A) Aseptic loosening resulted in fenestration of the anterior cortex of the ulna. (B) Revision surgery was performed using a fibular allograft.

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  Fig. 7. Aseptic loosening was identified in the layer between the stem and cement.

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  Fig. 8. (A, B) Failed unlinked prosthesis. (C, D) Severe metallosis and wear were identified. (E, F) The unstable prothesis (unlinked) was replaced with a semiconstrained model.

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  Fig. 9. Only polyethylene and bushing were changed. Both stems were strongly fixed in the humerus and ulna.

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  Fig. 10. Nearly full thickness wear of polyethylene was accompanied by metal erosion (grade 3b).

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  Fig. 11. (A) Periprosthetic fracture of the ulna (type I). (B) Proper healing was seen by conservative management at 1-year follow-up.

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  Fig. 12. (A) Periprosthetic fracture (type III). (B, C) Plating and wiring on the stable humerus stem was performed. (D, E)

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  Fig. 13. Bone defects due to comminuted periprosthetic fractures were managed using an allograft-prosthesis composite with a long humeral stem. The stability of the ulna stem was maintained.

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  Fig. 14. Bone defects due to comminuted periprosthetic fractures were managed using an allograft-prosthesis composite (type III). Courtesy from Prof. Joo Yup Lee.

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  Fig. 15. Wound dehiscence healed without further progression to a secondary infection.

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  Fig. 16. Insufficient wound healing resulted in a deep infection around the prosthesis.

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  Fig. 17. (A) A case of infected total elbow arthroplasty was referred for treatment 4 years after the index surgery. The symptoms began 2 months prior. (B) All prostheses were pulled out, and antibiotic beads were inserted. During removal, cement and bone were inevitably broken. (C) Three months later, revision surgery was performed with a new prosthesis, and there were no symptoms of infection during 3 years of follow-up.

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  Fig. 18. (A) Through either a midline incision or the radial border of the triceps, a humeral or ulnar stem was inserted. (B) In comminuted distal humeral fractures, the triceps-preserving method was easily used after resection of comminuted fragments.

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