Updated: 6/6/2021

Elbow Partial Arthroplasty

0%
Topic
Review Topic
0
0
0%
0%
Videos / Pods
1
Topic
Images
https://upload.orthobullets.com/topic/12111/images/ulnohumeral arthroplasty_moved.jpg
https://upload.orthobullets.com/topic/12111/images/ularthr_moved.jpg
https://upload.orthobullets.com/topic/12111/images/radial head excision_moved.jpg
https://upload.orthobullets.com/topic/12111/images/distal_humerus_hemi_xray_copy.jpg
https://upload.orthobullets.com/topic/12111/images/s.jpg
  • Introduction
    • Forms of elbow arthroplasty
      • total elbow arthroplasty
      • elbow hemiarthroplasty
        • radiocapitellar
        • distal humeral (not FDA approved)
      • ulnohumeral distraction & interpositional arthroplasty
      • ulnohumeral debridement arthroplasty
      • radial head excision
      • radial head arthroplasty
  • Elbow Hemiarthroplasty
    • Introduction
      • non-FDA approved hemiarthroplasty of either radiocapitellar joint or distal humerus
      • thought to avoid capitellar degeneration
  • Ulnohumeral Arthroplasty (distraction interposition)
    • Introduction
      • resection followed by contouring of articular surfaces with fascial interposition
      • addition of distraction external fixator allows early motion
    • Indications
      • young active patients with posttraumatic arthritis too young to follow TEA restrictions
      • ligamentously stable elbow
    • Approach
      • posterior midline skin incision
      • Kocher's interval
      • extensor musculature and LUCL complex released
      • if aconeus is to be used, release ulnar attachment
      • triceps released from lateral olecranon attachment, ulnar subluxated and elbow flexed to expose distal humerus
    • Bone work
      • distal humerus and ulnar surfaces prepared with saw or rongeur to create congruent surface
      • all osteophytes and cartilage removed to expose subchondral bone
    • Soft tissue
      • ulnar nerve transposed if symptomatic or prone to subluxate
      • capsular release performed to address contractures
    • Instrumentation
      • local aconeus autograft, tensor fascia autograft or Achilles allograft interposed in joint, sutured into place to cover distal humerus
      • graft may be pulled through bone tunnels to address collateral insufficiency
      • hinged external fixator placed to distract joint and allow early motion
    • Complications
      • bony resorption, joint subluxation, heterotopic ossification
    • Outcomes
      • less predictable than TEA
      • reasonable pain relief achieved in short-term and intermediate-term
      • worse outcomes if residual instability present
  • Ulnohumeral Debridement Arthroplasty¬†(Outerbridge-Kashiwagi procedure)
    • Indications
      • joint space narrowing
      • osteophytes (especially in posteromedial olecranon)
    • Approach
      • arthroscopic debridement for mild disease and no prior ulnar nerve transposition
      • open debridement for severe disease with inaccessible joint space
        • posterior triceps-splitting approach
        • lateral column approach allows better access to anterior joint
    • Bone work
      • osteophytes and soft tissues removed from olecranon tip and fossa
      • olecranon fossa opened with burr or trephine to access coronoid fossa
      • osteotome to resect coronoid osteophytes
    • Soft tissue
      • capsular release may be done in conjunction if contracture present
      • generally the ulnar nerve is transposed if pre-operative range of motion less than 90 degrees
    • Complications
      • lesser outcomes with failure to release all causative osteophytes
      • failure to recognize and address ulnar neuropathy with release or transposition leads to inferior outcomes
    • Outcomes
      • improvements in motion and pain with both arthroscopic and open procedures
  • Radial Head Excision
    • Indications
      • rheumatoid arthritis isolated to the radiocapitellar joint
      • unreconstructable radial head fracture in ligamentously stable elbow
    • Approach
      • performed using either Kocher or Kaplan's interval
      • supinator muscle fibers and capsule split longitudinally
    • Bone work
      • resect any bony fragments
      • resect as little radial neck as possible
      • use fluoroscopy to evaluate stability of elbow and distal radioulnar joint following resection
    • Instrumentation
      • none
    • Complications
      • progressive degenerative changes in ulnohumeral joint of unclear significance
      • radial shortening and wrist pain, likely secondary to unrecognized interosseous injury
    • Outcomes
      • increase in valgus elbow carrying angle
  • Radial Head Arthroplasty
    • Indications
      • unreconstructable radial head fracture
      • radial head malunion or nonunion
      • radiocapitellar arthritis
    • Approach
      • performed using either Kocher or Kaplan's interval
      • supinator muscle fibers and capsule split longitudinally
    • Soft tissue
      • LUCL complex may be taken down for visualization but must be repaired
    • Bone work
      • level of saw cut at the base of radial neck
      • proximal canal broached to anatomic fit
    • Instrumentation
      • size the native radial head if intact
      • trial implant to assess for gapping or overstuffing of joint
      • lesser sigmoid notch can serve as landmark if using fluoroscopy
      • assess fit in both extension and flexion
    • Complications
      • capitellar degeneration due to overstuffing joint

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
Cards
1 of 0
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (0)
Private Note