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Elbow Implant
Jonelle M. Petscavage-Thomas, MD, MPH; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Elbow arthroplasty: replacement of distal humerus and proximal ulna portions of elbow joint
              • Hinged implant
                • Implant is stable
                • Semiconstrained/linked implant
                  • Uses pin, which allows small amount of rotation and varus-valgus angulation (7-10°)
                  • Most commonly used total elbow prosthesis
                • Convertible implant
                  • Allows surgeon to choose between semiconstrained and unconstrained mechanism
              • Unlinked or uncoupled implant
                • Inherently less stable than hinged implant
                  • Requires normal underlying bone stock
                  • Stabilizing soft tissues must be intact (muscles, tendons, and collateral ligaments)
                • Increased rate of dislocation (13%) but decreased rate of loosening
            • Hemiarthroplasty: replacement of only 1 portion of joint
              • Humeral and ulnar hemi-implants not used secondary to high failure rate
              • Radial head implant used but has high rate of failure
                • Unipolar or bipolar (allows rotation of head up to 15°)
              • Capitellum resurfacing
                • Often used with radial head implant for lateral elbow resurfacing
            • Arthroplasty is procedure; device = prosthesis, implant, replacement

          IMAGING

          • Radiographic Findings

            PATHOLOGY

            • Staging, Grading, & Classification

              • Indications for Elbow Arthroplasty

                CLINICAL ISSUES

                • Natural History & Prognosis

                  DIAGNOSTIC CHECKLIST

                  • Consider

                    Selected References

                    1. Kwak JM et al: Total elbow arthroplasty: clinical outcomes, complications, and revision surgery. Clin Orthop Surg. 11(4):369-79, 2019
                    2. Welsink CL et al: Total elbow arthroplasty: a systematic review. JBJS Rev. 5(7):e4, 2017
                    3. Prkić A et al: Total elbow arthroplasty is moving forward: review on past, present and future. World J Orthop. 7(1):44-9, 2016
                    4. Roth E et al: Imaging of elbow replacement arthroplasty. Semin Musculoskelet Radiol. 19(1):60-6, 2015
                    5. Wagener ML et al: Mid-term clinical results of a modern convertible total elbow arthroplasty. Bone Joint J. 97-B(5):681-8, 2015
                    6. Ha AS et al: Radial head arthroplasty: a radiologic outcome study. AJR Am J Roentgenol. 199(5):1078-82, 2012
                    7. Petscavage JM et al: Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty. Radiographics. 32(1):129-49, 2012
                    8. McDonald CP et al: Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty. J Shoulder Elbow Surg. 19(4):533-43, 2010
                    9. Prasad N et al: Outcome of total elbow replacement for rheumatoid arthritis: single surgeon's series with Souter-Strathclyde and Coonrad-Morrey prosthesis. J Shoulder Elbow Surg. 19(3):376-83, 2010
                    10. Throckmorton T et al: Failure patterns after linked semiconstrained total elbow arthroplasty for posttraumatic arthritis. J Bone Joint Surg Am. 92(6):1432-41, 2010
                    11. Celli A et al: Total elbow arthroplasty in patients forty years of age or less. J Bone Joint Surg Am. 91(6):1414-8, 2009
                    12. Chalidis B et al: Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury. 40(6):582-90, 2009
                    13. Fevang BT et al: Results after 562 total elbow replacements: a report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg. 18(3):449-56, 2009
                    14. Patil N et al: High revision rate after total elbow arthroplasty with a linked semiconstrained device. Orthopedics. 32(5):321, 2009
                    15. Sanchez-Sotelo J et al: Linked elbow replacement: a salvage procedure for distal humeral nonunion. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:200-12, 2009
                    16. Skyttä ET et al: Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register. Acta Orthop. 80(4):472-7, 2009
                    Related Anatomy
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Imaging

                        • Clinical Issues

                          • Diagnostic Checklist

                            TERMINOLOGY

                            • Definitions

                              • Elbow arthroplasty: replacement of distal humerus and proximal ulna portions of elbow joint
                                • Hinged implant
                                  • Implant is stable
                                  • Semiconstrained/linked implant
                                    • Uses pin, which allows small amount of rotation and varus-valgus angulation (7-10°)
                                    • Most commonly used total elbow prosthesis
                                  • Convertible implant
                                    • Allows surgeon to choose between semiconstrained and unconstrained mechanism
                                • Unlinked or uncoupled implant
                                  • Inherently less stable than hinged implant
                                    • Requires normal underlying bone stock
                                    • Stabilizing soft tissues must be intact (muscles, tendons, and collateral ligaments)
                                  • Increased rate of dislocation (13%) but decreased rate of loosening
                              • Hemiarthroplasty: replacement of only 1 portion of joint
                                • Humeral and ulnar hemi-implants not used secondary to high failure rate
                                • Radial head implant used but has high rate of failure
                                  • Unipolar or bipolar (allows rotation of head up to 15°)
                                • Capitellum resurfacing
                                  • Often used with radial head implant for lateral elbow resurfacing
                              • Arthroplasty is procedure; device = prosthesis, implant, replacement

                            IMAGING

                            • Radiographic Findings

                              PATHOLOGY

                              • Staging, Grading, & Classification

                                • Indications for Elbow Arthroplasty

                                  CLINICAL ISSUES

                                  • Natural History & Prognosis

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Kwak JM et al: Total elbow arthroplasty: clinical outcomes, complications, and revision surgery. Clin Orthop Surg. 11(4):369-79, 2019
                                      2. Welsink CL et al: Total elbow arthroplasty: a systematic review. JBJS Rev. 5(7):e4, 2017
                                      3. Prkić A et al: Total elbow arthroplasty is moving forward: review on past, present and future. World J Orthop. 7(1):44-9, 2016
                                      4. Roth E et al: Imaging of elbow replacement arthroplasty. Semin Musculoskelet Radiol. 19(1):60-6, 2015
                                      5. Wagener ML et al: Mid-term clinical results of a modern convertible total elbow arthroplasty. Bone Joint J. 97-B(5):681-8, 2015
                                      6. Ha AS et al: Radial head arthroplasty: a radiologic outcome study. AJR Am J Roentgenol. 199(5):1078-82, 2012
                                      7. Petscavage JM et al: Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty. Radiographics. 32(1):129-49, 2012
                                      8. McDonald CP et al: Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty. J Shoulder Elbow Surg. 19(4):533-43, 2010
                                      9. Prasad N et al: Outcome of total elbow replacement for rheumatoid arthritis: single surgeon's series with Souter-Strathclyde and Coonrad-Morrey prosthesis. J Shoulder Elbow Surg. 19(3):376-83, 2010
                                      10. Throckmorton T et al: Failure patterns after linked semiconstrained total elbow arthroplasty for posttraumatic arthritis. J Bone Joint Surg Am. 92(6):1432-41, 2010
                                      11. Celli A et al: Total elbow arthroplasty in patients forty years of age or less. J Bone Joint Surg Am. 91(6):1414-8, 2009
                                      12. Chalidis B et al: Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury. 40(6):582-90, 2009
                                      13. Fevang BT et al: Results after 562 total elbow replacements: a report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg. 18(3):449-56, 2009
                                      14. Patil N et al: High revision rate after total elbow arthroplasty with a linked semiconstrained device. Orthopedics. 32(5):321, 2009
                                      15. Sanchez-Sotelo J et al: Linked elbow replacement: a salvage procedure for distal humeral nonunion. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:200-12, 2009
                                      16. Skyttä ET et al: Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register. Acta Orthop. 80(4):472-7, 2009