Total Elbow Arthroplasty: Elbow Biomechanics and Failure

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

“…Nonconstrained TEAs have low intrinsic stability and rely on soft-tissue balancing. The primary stabilizers of nonconstrained TEA are the medial and lateral collateral ligaments, 20) and the posterior capsule and surrounding muscles function as secondary stabilizers. This is because postoperative instability is a major complication of unlinked prostheses.…”

“…It allows some varus-valgus motion, reducing stress concentration on the bone-cement interface. 20,[23][24][25] The implant permits 7°-10° of varus-valgus movement and 7°-10° of axial rotation of the knee. Adding an anterior flange to the humeral component also protects the bone-cement interface from stress forces.…”

“…25,[29][30][31][32][33][34][35][36] However, aseptic loosening together with bushing wear is a leading complication of implant failure, and reducing the complication rate remains a challenge. 13,20,24,37) Semiconstrained Condylar-Bearing Design (Discovery Elbow System) The Discovery Elbow System (Biomet LLC, Warsaw, IN, USA) is a hemispherical linked prosthesis designed to decrease complications associated with a semiconstrained prosthesis, especially bushing wear. 26) Its minimally constrained design allows a close match of the articular surfaces, avoids the use of a true hinge, and anatomically reproduces the axis of elbow motion.…”

“…26,37,88,89) This bone resorption increases the moment of force on the arm between the hinge and the site where the stem transfers most of its load, which not only predisposes to loosening of the stem but also increases the likelihood of arthroplasty failure due to polyethylene wear, mechanical failure, or periprosthetic fracture. 11,20,26,37,49,88,89) Loose stems are amenable to revision TEA generally using a longer stem, with bone grafting performed if indicated. 20,88,90) King et al 91) reported a series of 31 patients who underwent revision TEA due to aseptic loosening with a mean 6-year follow-up.…”

“…11,20,26,37,49,88,89) Loose stems are amenable to revision TEA generally using a longer stem, with bone grafting performed if indicated. 20,88,90) King et al 91) reported a series of 31 patients who underwent revision TEA due to aseptic loosening with a mean 6-year follow-up. The mean MEPS was 87, and the mean flexion-extension arc was > 100°.…”