TOTAL ELBOW ARTHROPLASTY
‣
- Linked and fully constrained hinged design [Historical]
- First designs were linked
- High cement bone interface stresses
- Unlinked
- Developed due to aseptic loosening in linked designs
- Soft tissue ligaments must be intact
- Linked but semi constrained = Sloppy hinge**
‣
- Sloppy hinge - Allows 8 deg varus/ Valgus.
- Less constraint = Less cement- bone interface stress
- Presence of anterior flange in Coonrad- Morrey design to provide rotational stability and reduce osteolysis and wear
- Added bone block at trochlea to increase bone stock where maximum stress occurs
- Titanium material - similar stiffness to bone
‣
- As per Danish Registry -
- Most common = aseptic loosening
- Second = periprosthetic fracture
- 3rd = infection
- Bushing wear?
‣
- Will require an extensile approach e.g. Bryan Morrey or TRAP approach
- Cannot use olecranon osteotomy.
- Other option is a paraolecranon approach
‣
- Different etiologies
- in RA, we expect more instability due to ligament attenuation.
- RA - higher risk of septic loosening
- in post-traumatic OA, we expect more stiff ligaments
- OA - higher risk of bushing wear, axle failure and component disassembly, intra-operativ fractures
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896228/
FUSION
‣
- Unilateral = 90 deg flexion (for feeding), 10 ° in supination!
- Bilateral
- One in 90 deg
- One in slight extension 65 deg for perineal care