Failed arthroplasty of the elbow

Author: Jetske Viveen

Viveen, Jetske, 2019 Failed arthroplasty of the elbow, Flinders University, College of Medicine and Public Health

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The elbow is an essential joint to position our hand in space and thus vital to be able to perform most basic daily activities. Therefore, it is important to restore elbow function after complex elbow fractures or sequalae of posttraumatic deformities. In selective trauma cases, when the fracture is considered not amenable to achieve the main goal of open reduction-internal fixation – a functional elbow – total or partial elbow arthroplasty can be an option. Functional outcomes after primary elbow arthroplasty are generally favorable, however the complication and revision rates remain relatively high and improvements to optimize outcomes could well be made.

Therefore, the general aim of this thesis was to improve the results of (failed) elbow arthroplasties, including the treatment of complex elbow trauma with arthroplasties. Part I focused on radial head arthroplasty (RHA) with specific interest in anatomy of the radial head, indications, diagnosis and management of revision surgery and the radiographic and clinical outcomes thereafter. In Part II, the focus was on total elbow arthroplasty (TEA); anatomy of the proximal ulna was studied in detail, analysis of global trends on indications for primary and revision surgery of TEA was done and radiographic and clinical outcomes after revision surgery were assessed.

RHA is commonly performed in case of comminuted radial head fractures. In the last decade, a similar trend has been observed for TEA in case of complex elbow fractures. Although the clinical outcomes after primary elbow arthroplasty are considered favorable under the circumstances, the long-term complication and failure rates remain relatively high in comparison to for example THA and TKA. The most prevalent indication for revision surgery in elbow arthroplasty is aseptic symptomatic loosening, followed by infection in TEA and stiffness and persistent pain in RHA. Despite a high complication rate, the functional outcomes after revision surgery of elbow arthroplasties are considered satisfactory, including improvement of range of motion, stability, pain scores and outcomes of PROMs. Therefore, revision surgery of elbow arthroplasties is regarded as a salvage procedure. However, this relatively high complication rates particularly in revision TEA should be discussed with the patient in advance.

Keywords: Radial head arthroplasty, Total elbow arthroplasty, revision surgery

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Medicine and Public Health
Supervisor: prof. Ruurd Jaarsma