Interposition Elbow Arthroplasty

Abstract

Pain and loss of motion associated with elbow arthritis is poorly tolerated and constitutes a major functional impairment. While total elbow arthroplasty reliably alleviates pain and improves motion, durability issues mandate restricted indications and light use. Interposition arthroplasty, combined with hinged external fixation, is an alternative and may be preferred in younger, more active patients anticipating heavier use.

The Posttraumatic Stiff Elbow: A Review of the Literature

“…174 Resurfacing materials may include autologous fascia lata from the thigh, autologous skin, or an allograft such as an Achilles' tendon. 156,158,173,175 When the ulnar nerve is symptomatic, a medial interval may be chosen. 156,176 Otherwise, a lateral interval is used.…”

“…156,158,173,175 When the ulnar nerve is symptomatic, a medial interval may be chosen. 156,176 Otherwise, a lateral interval is used. A posterior skin incision or previous incision may be used followed by development of a Kocher's interval between anconeus and extensor carpi ulnaris.…”

“…106 Interposition Arthroplasty Whereas total elbow replacement may be a viable option to restore motion and relieve pain in the older and less active patient with severely damaged articular surface, 89,107,155 interposition arthroplasty may be indicated to restore function and relieve pain in younger and more active patients, withstanding the functional demands. 17,154,156,158,173,174 The goal of interposition arthroplasty is to preserve functional stability and to reduce the likelihood of reankylosis by interposing a substance between the resected bone ends. 174 Resurfacing materials may include autologous fascia lata from the thigh, autologous skin, or an allograft such as an Achilles' tendon.…”

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

“…tendon allograft 4 , AlloDerm (LifeCell, Branchburg, New Jersey) 5 , bovine collagen 6 , Gelfoam (Pharmacia and Upjohn, Kalamazoo, Michigan) 7 , and silicone 8 . Hinged external fixation has been used as a means of initiating early motion while neutralizing forces and thus protecting the soft tissues, the interposed graft, and any ligament repair or reconstruction 9 .…”

A retrospective review of a series of interposition arthroplasties of the elbow

“…Throughout the years, various interposition tissues have been used, varying from synthetic grafts to the current preferred option of Achilles tendon allograft [9][10][11] with or without a hinged external fixator as an adjunct [12]. It is considered as a salvage option in patients where conservative treatment has failed and total elbow arthroplasty is relatively contraindicated [10].…”