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Present state-of-the-art in elbow arthroplasty.
1Schulthess Clinic, Lengghalde 2, CH-8008 Zurich, Switzerland.
Acta Orthopaedica Belgica
|June 8, 2002
Summary
Elbow replacement surgery is becoming routine, with linked prostheses showing good short-term results. Long-term survival is high for rheumatoid arthritis, but complications are more frequent in post-traumatic cases.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Elbow joint replacement is increasingly common, particularly in specialized centers.
- Indications have shifted from primarily rheumatoid arthritis to include more post-traumatic osteoarthritis.
- Few prosthetic devices have demonstrated long-term efficacy (>10 years).
Purpose of the Study:
- To review the current state of elbow prosthetic joint replacement.
- To compare linked and non-linked prosthesis types and their indications.
- To analyze short- and long-term outcomes and complication rates.
Main Methods:
- Meta-analysis of world literature on elbow prostheses.
- Distinction between linked (sloppy hinges) and non-linked (resurfacing) prostheses.
- Review of fixation methods (cemented) and specific designs (e.g., GSB III, Coonrad-Morrey).
Main Results:
- Linked prostheses, especially sloppy hinges, offer a wider range of indications and reduced interface stress.
- Resurfacing prostheses require intact bone stock and ligaments.
- Short-term pain relief and mobility are satisfactory; 10-year survival in rheumatoid arthritis is ~90%.
- Complication rates are higher in post-traumatic osteoarthritis than in rheumatoid arthritis, especially in younger patients.
Conclusions:
- Properly placed elbow prostheses provide good initial results.
- Linked, sloppy-hinge designs with features like condylar configurations or anterior flanges show better long-term outcomes.
- Complication rates, including aseptic loosening, infection, instability, and ulnar nerve issues, remain a concern, necessitating anatomical preservation.