Interposition Arthroplasty with an Achilles Tendon Allograft as a Salvage Procedure for the Elbow

Abstract

We consider interposition elbow arthroplasty to be a salvage procedure as it neither completely eliminates pain nor restores full function. It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis, especially those with limited elbow motion. Furthermore, we do not recommend this procedure when patients present with preoperative instability on physical examination.

Complication and Revision Rates Following Total Elbow Arthroplasty

“…[1][2][3][4] Elbow arthroplasty is a viable option for end-stage disease, and therefore it is important to know the rates of potential complications. Multiple studies have described the most common complications, including infection, nerve injury, and implant failure.…”

Elbow rheumatoid elbow: surgical treatment options

“…The exposure most commonly reported in the literature for interposition arthroplasty is the extensile Kocher's approach, with detachment of the origin of the lateral collateral ligament from its humeral origin, and partial versus complete detachment of the triceps insertion from lateral to medial [17].…”

“…The fixator is removed 3-6 weeks later. Larson and Morrey analyzed the results of interposition arthroplasty for inflammatory arthritis as part of a larger group of 69 interposition arthroplasties performed using an Achilles tendon allograft [17]. Two patients had complete ankylosis.…”

Elbow Arthritis: Current Concepts

“…Interposition arthroplasty does not carry the same weight-lifting restriction as total elbow arthroplasty does (5-kg lifting restriction) and may be more durable in the active patient. 12,13 A fixed varus or valgus deformity of Ͼ10°is considered to be a contra- indication because of the resultant increased shear stresses across the graft. 12 Larson and Morrey 12 reported their outcomes of interposition arthroplasty performed with an Achilles' tendon allograft, ligamentous reconstruction, and an articulated external fixator to protect the soft tissues during the healing phase.…”

“…12,13 A fixed varus or valgus deformity of Ͼ10°is considered to be a contra- indication because of the resultant increased shear stresses across the graft. 12 Larson and Morrey 12 reported their outcomes of interposition arthroplasty performed with an Achilles' tendon allograft, ligamentous reconstruction, and an articulated external fixator to protect the soft tissues during the healing phase. In their study of 45 patients, the underlying elbow arthritis was inflammatory in 11 patients and posttraumatic in 34.…”