[Total elbow arthroplasty as a treatment option in complex injuries of the elbow in elderly patients]

The aim of this study was to evaluate the functional outcome of patients with severe elbow injuries treated by primary and secondary implantation of an elbow prosthesis using two different functional scores.

To determine whether or not total elbow replacement is an acceptable treatment option in such cases, we analysed the functional outcome of patients after primary or secondary implantation of the semi-constrained Coonrad-Morrey prosthesis. Between March 2005 and September 2009 we implanted 25 Coonrad-Morrey prostheses in 24 patients with acute or chronic elbow injuries. Eight patients had complex type C3 fractures according to the AO classification and were treated with primary implantation. 16 patients received a secondary implantation including 3 chronic luxations, 3 non-unions of the bone, 3 failed osteosyntheses, 7 patients with post-traumatic arthrosis and 1 reimplantation. The mean follow-up after the operation was 12 (± 8) months. The functional outcome was measured by assembling the "Mayo elbow prosthesis score" and the "Mayo elbow performance score". We had 15 female and 9 male patients with a mean age of 67 (± 6) years.

All 24 patients achieved very good results based on the used scores with a mean of 97 points each with a maximum performance of 100 points. The mean range of motion concerning extension and flexion was 92 degrees (range 55 to 115 degrees), concerning pronation and supination 144 degrees (range 100 to 160 degrees). The mean flexion deformity was 19 degrees (range 10 to 50 degrees), the mean maximum flexion was 112 degrees (range 90 to 130 degrees). During the follow-up we had two partial ruptures of the triceps tendon, one temporary lesion of the ulnar nerve with complete recovery after surgical revision and one postoperative haematoma which needed surgical treatment. One patient needed revision surgery and resection arthroplasty due to a deep infection, but received a new prosthesis after two months. We recorded no radiographic loosening or other mechanical problems.

Due to the good functional outcome and pain relief of patients treated by total elbow replacement, we suggest that total elbow arthroplasty is a reasonable treatment option for complex acute and chronic injuries of the elbow in elderly patients.