Primary elbow arthroplasty: problems and solutions

Abstract

Prosthetic replacement of the elbow joint has continued to improve over time. Widespread implantation of certain designs has led to identification a few successful elements of elbow arthroplasty, as well as several opportunities for improvement. Current hot topics in elbow arthroplasty include triceps-preserving exposures, implantation of components with better-expected wear performance, management of the ulnar nerve, prevention of infection, and the development of successful cementless components. Total elbow arthroplasty has the potential to improve pain, function and quality of life for many patients with articular destruction secondary to inflammatory arthropathy or as a consequence of trauma. Continued advances in this field are key to make this operation as reliable and lasting as hip or knee arthroplasty.

Keywords: arthroplasty; elbow; surgical advances.

Figure 1.

Triceps-off exposures.

Figure 2.

Triceps-on exposures.

Figure 3.

Anteroposterior radiograph 20 years after a Coonrad–Morrey elbow arthroplasty was implanted in a patient with rheumatoid arthritis.

Figure 4.

Lateral radiograph 20 years after a Coonrad–Morrey elbow arthroplasty was implanted in a patient with rheumatoid arthritis.

Figure 5.

Lateral radiograph shows catastrophic loosening of the ulnar component with severe osteolysis and a periprosthetic fracture.

Figure 6.

Modern elbow implants offer a high-performance articulation and the possibility of lateral column load sharing.

Figure 7.

Anteroposterior radiograph of a patient with long-standing deformity of the elbow secondary to a childhood injury.

Figure 8.

Lateral radiograph of a patient with long-standing deformity of the elbow secondary to a childhood injury.