Elbow interposition arthroplasty in a young adult: A case report

Abstract

Introduction: Posttraumatic elbow arthritis in young adults is a rare yet challenging condition, presenting primarily with progressive pain and stiffness that limits functional activities. Achieving a functional, low-pain elbow joint with future treatment options is essential for younger, active patients. Unlike total elbow arthroplasty (TEA), which is prone to loosening in young patients, interposition arthroplasty (IA) offers bone preservation, pain reduction, and improved joint function.

Case presentation: A 22-year-old male presented with four years of right elbow pain and stiffness following a sports-related injury. Initial closed reduction and subsequent surgeries led to progressive stiffness. The patient underwent IA with a fascia lata graft and controlled postoperative physiotherapy. Postoperative management included a 6-week removable POP slab and a 24-week hinged brace, allowing for active range of motion exercises starting at 3-4 weeks.

Clinical discussion: Interposition arthroplasty (IA) has become a viable alternative to total elbow arthroplasty (TEA), especially in younger, active patients. IA aims to restore joint function by interposing a biological material such as a fascia lata graft between the damaged bone surfaces of the joint. The fascia lata graft acts as a spacer, reducing pain and facilitating improved motion while preserving the underlying bone structure. The use of this technique is particularly advantageous in patients with posttraumatic arthritis, where joint preservation is crucial, and the long-term risk of implant loosening is a concern with traditional arthroplasty.

Conclusion: This case illustrates IA as a viable surgical alternative for young patients with posttraumatic elbow arthritis, achieving significant improvements in range of motion and daily function.

Keywords: Elbow joint preservation; Fascia lata graft; Functional outcomes; Interposition arthroplasty; Posttraumatic elbow arthritis; Range of motion.

Fig. 1

Anteroposterior radiograph of the right elbow demonstrating a medial plate and two K-wires in situ, following a previous open reduction and internal fixation for an intra-articular distal humerus fracture. Note the absent radial head, likely due to prior resection.

Fig. 2

Lateral radiograph of the right elbow showing hardware from previous fixation of a distal humerus fracture. The radial head is absent, and there is evidence of arthritic changes.

Fig. 3

Intraoperative photograph demonstrating the debrided articular surfaces of the distal humerus and proximal ulna, prepared for graft interposition. The capitellum, trochlea, and proximal ulna have been smoothed to ensure optimal graft fit and joint movement.

Fig. 4

Intraoperative photograph showing the harvested fascia lata autograft. The graft has been sized to fit the debrided articular surfaces.

Fig. 5

Intraoperative photograph demonstrating the fascia lata autograft secured to the periarticular tissue using non-absorbable sutures in a horizontal mattress pattern.

Fig. 6

Week 6 post-operative showing 95 degrees of elbow flexion.

Fig. 7

Week 6 post-operative showing 100 degrees of elbow extension.