Total Elbow Arthroplasty: Why and How

Abstract

Introduction: Elbow arthroplasty is a relatively infrequent orthopaedic procedure that can be performed in multiple ways according to the type of prosthesis that is used and the needs of the individual patient.

Step 1 preparation and positioning of the patient: Place the patient in the lateral decubitus position or in the supine position with the arm draped, allowing for easy manipulation of the elbow during the procedure.

Step 2 incision: Palpate and mark the local osseous landmarks, ulnar nerve, and incision, and then make a posterior incision to allow 360° access to the elbow joint as well as to allow decompression or transposition of the ulnar nerve.

Step 3 approach—the superficial layer: Perform the superficial approach, including a decompression of the ulnar nerve, and properly visualize the triceps tendon attachment on the proximal part of the ulna and both epicondyles.

Step 4 approach—the deep layer: Mobilize the triceps to allow visualization of the articular surfaces of the ulna, humerus, and radius, while taking care to protect the ulnar nerve.

Step 5 preparation of the osseous structures: Prepare the humerus and ulna in conformance with the technique that is described for the prosthesis and take care to restore the anatomical flexion-extension axis of the elbow.

Step 6 placement of the prosthesis: When all trial components are in place, reduce the joint to test the stability of the elbow.

Step 7 closure of the elbow: When all of the definitive components of the total elbow arthroplasty are in place, close the surgical wound in layers as the anatomy is restored.

Step 8 postoperative care: After surgery, a wound dressing is applied and physical rehabilitation is started to maximize the functional outcome.

Results: In our study of the mid-term results of a convertible total elbow arthroplasty, based on 58 elbow arthroplasties, patients had significant improvement in range of movement, function, and pain at 6 months postoperatively⁸.