<p>Total elbow replacement &ndash; patient selection and perspectives</p>

Abstract

Total joint replacements for elbow arthritis were developed in the late 1960s at the same time as total joint replacements for knee joint arthritis. Since then, there has been a continuing annual increase in the number of patients treated with total knee joint replacement for arthritis, in line with replacement arthroplasty of the other major limb joints, but in contrast to total elbow joint replacement which is falling, since reaching a peak in the 1990s. Which raises the question, why? Continuing controversy about implant design, the relatively high reported complication rates associated with total elbow replacement (TER) and the difficulties encountered in revision surgery are identified as reasons together with changes in the patient population currently treated with TER. The purpose of this review is to explore the reasons for this in the context of the patient population requiring implant surgery for elbow arthritis and our current perspective of elbow pathology requiring treatment. This is not a systematic review of the whole of the literature concerning total elbow joint replacement arthroplasty but is drawn largely from the supporting literature that reflects my own clinical experience and illustrated with teaching materials I have commissioned together with radiographs and intraoperative photographs of patients I have treated.

Modified Masquelet Technique Assisting 3D Printed Elbow Prosthesis for Open Elbow Fracture with Severe Bone Defect: A Case Report and Technique Note

“…Intraoperatively, the patient was in a supine position. A posterior surgical approach was taken to expose the affected elbow, and the ulnar nerve was isolated 16 . Then the PMMA spacer was taken out.…”

“…A posterior surgical approach was taken to expose the affected elbow, and the ulnar nerve was isolated. 16 Then the PMMA spacer was taken out. After determining the anatomical structure, a curette was used to remove the fibrous tissue and membrane inserted in the medullary cavity at both bone defeat extremities and the prosthesis contact surface, so that the vascularization was restarted.…”

“…Total elbow arthroplasty (TEA) has been traditionally used for inflammatory arthropathy, but it has become an increasingly common treatment for trauma 15,16 . Studies reported that TEA could achieve a good or excellent functional outcome compared to ORIF in treating distal humerus fractures, especially for severely comminuted fractures, bone defect, destruction of the articular surface, or elbow instability 2 .…”

“…Total elbow arthroplasty (TEA) has been traditionally used for inflammatory arthropathy, but it has become an increasingly common treatment for trauma. 15 , 16 Studies reported that TEA could achieve a good or excellent functional outcome compared to ORIF in treating distal humerus fractures, especially for severely comminuted fractures, bone defect, destruction of the articular surface, or elbow instability. 2 Furthermore, the three‐dimensional (3D) technique and 3D printed prosthesis have enabled elbow replacement to flourish, addressing the intractable problem of traumatic bone loss without redundant osteotomy.…”

Outcomes of Total Elbow Arthroplasty in Trauma Patients Compared with Patients Following Fixation of Distal Humerus Fractures

“…[3,4] Moreover, the healing process of intra-articular fractures involving both columns of the distal humerus may be halted since fragments are mostly covered with cartilage and are thus deprived of sufficient soft tissue and blood supply. [5] These inherent drawbacks in intraarticular fractures of the distal humerus may lead to poor outcomes including functional limitation and decreased range of motion, non-union, and consequently, a relatively high rate of secondary surgeries. [6,7] As high as 20% of patients who have sustained distal humeral fractures have demonstrated either loss of function, dissatisfaction, or sub functional range of motion.…”