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Elbow Implant
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 humeral and proximal ulnar portions of elbow joint
              • Hinged implant
                • Also termed linked or coupled
                • Implant is stable
                • Older components invariably loosened because hinge did not allow rotation
                • Newer design: Uses pin, which allows small amount of rotation and varus-valgus angulation (7-10°)
                  • Termed semiconstrained linked implant
                  • Most commonly used total elbow arthroplasty
              • Unlinked or uncoupled implant
                • Inherently less stable than hinged implant
                  • Requires normal underlying bone stock
                  • Stabilizing soft tissues must be intact (muscles, tendons, and radial and ulnar collateral ligaments)
                • Alignment is technically difficult
                  • Requires excellent surgical technique
                • Increased rate of dislocation (13%) but decreased rate of loosening
            • Hemiarthroplasty: Replacement of only 1 portion of joint
              • Humeral and ulnar hemiarthroplasties 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°)
            • Cadaveric allograft
              • Salvage procedure
              • Prone to nonunion and instability

          IMAGING

          • Radiographic Findings

            PATHOLOGY

            • Staging, Grading, & Classification

              • Indications for Elbow Implant

                • Indications for Cadaveric Allograft

                  CLINICAL ISSUES

                  • Natural History & Prognosis

                    DIAGNOSTIC CHECKLIST

                    • Consider

                      Selected References

                      1. Ha AS et al: Radial head arthroplasty: a radiologic outcome study. AJR Am J Roentgenol. 199(5):1078-82, 2012
                      2. Petscavage JM et al: Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty. Radiographics. 32(1):129-49, 2012
                      3. 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
                      4. 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
                      5. 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
                      6. 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
                      7. 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
                      8. 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
                      9. Patil N et al: High revision rate after total elbow arthroplasty with a linked semiconstrained device. Orthopedics. 32(5):321, 2009
                      10. 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
                      11. 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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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Clinical Issues

                            • Diagnostic Checklist

                              TERMINOLOGY

                              • Definitions

                                • Elbow arthroplasty: Replacement of distal humeral and proximal ulnar portions of elbow joint
                                  • Hinged implant
                                    • Also termed linked or coupled
                                    • Implant is stable
                                    • Older components invariably loosened because hinge did not allow rotation
                                    • Newer design: Uses pin, which allows small amount of rotation and varus-valgus angulation (7-10°)
                                      • Termed semiconstrained linked implant
                                      • Most commonly used total elbow arthroplasty
                                  • Unlinked or uncoupled implant
                                    • Inherently less stable than hinged implant
                                      • Requires normal underlying bone stock
                                      • Stabilizing soft tissues must be intact (muscles, tendons, and radial and ulnar collateral ligaments)
                                    • Alignment is technically difficult
                                      • Requires excellent surgical technique
                                    • Increased rate of dislocation (13%) but decreased rate of loosening
                                • Hemiarthroplasty: Replacement of only 1 portion of joint
                                  • Humeral and ulnar hemiarthroplasties 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°)
                                • Cadaveric allograft
                                  • Salvage procedure
                                  • Prone to nonunion and instability

                              IMAGING

                              • Radiographic Findings

                                PATHOLOGY

                                • Staging, Grading, & Classification

                                  • Indications for Elbow Implant

                                    • Indications for Cadaveric Allograft

                                      CLINICAL ISSUES

                                      • Natural History & Prognosis

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Ha AS et al: Radial head arthroplasty: a radiologic outcome study. AJR Am J Roentgenol. 199(5):1078-82, 2012
                                          2. Petscavage JM et al: Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty. Radiographics. 32(1):129-49, 2012
                                          3. 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
                                          4. 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
                                          5. 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
                                          6. 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
                                          7. 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
                                          8. 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
                                          9. Patil N et al: High revision rate after total elbow arthroplasty with a linked semiconstrained device. Orthopedics. 32(5):321, 2009
                                          10. 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
                                          11. 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