Prosthetic replacement for coronoid deficiency: report of three cases

Area of Science:

• Orthopedic surgery
• Biomedical engineering

Background:

• Persistent elbow instability due to coronoid deficiency presents a significant treatment challenge.
• Existing surgical techniques for coronoid reconstruction yield unpredictable outcomes.
• A novel hypothesis suggests prosthetic replacement can restore elbow stability.

Observation:

• Three patients with chronic fracture-subluxation, coronoid deficiency, and radial head compromise underwent custom nonanatomical metallic coronoid prosthesis implantation.
• All patients had a history of 2-4 prior failed surgical interventions.
• Mean follow-up was 11 years (range 10-12 years).

Findings:

• Two patients achieved complete pain relief; the third reported minimal pain (VAS score ≤3/10).
• All patients maintained elbow joint stability.
• Radiographic evaluation confirmed proper prosthesis positioning without loosening.
• While functional range of motion was not fully restored, patient-reported outcomes were positive, with two rating themselves 'improved' and one 'almost normal'.

Implications:

• Prosthetic replacement of the coronoid is a viable strategy for managing chronic elbow instability secondary to coronoid deficiency.
• This technique demonstrates potential for improving patient-reported outcomes and joint stability in complex cases.
• Further research may explore optimizing functional range of motion following coronoid reconstruction.