Elbow Arthroplasty

Overview

Total elbow arthroplasty has progressed over time. Elbow implants can be linked or unlinked. Unlinked implants are appealing to patients with reasonably well maintained bone stock and ligaments, but linked implants are preferred by many because they minimize instability and allow replacement for a broader range of purposes.

Rheumatoid arthritis and other inflammatory arthropathies are the most common reasons for elbow arthroplasty. Posttraumatic osteoarthritis, acute distal humerus fractures, distal humerus nonunions, and repair following tumor removal are now among the indications.

Elbow arthroplasty is very successful in terms of pain relief, motion and function. However, its complication rate remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures, worse for patients with posttraumatic osteoarthritis.

The surfaces of the bones where they meet to create the elbow joint are covered by articular cartilage, a smooth material that protects and allows the bones to move freely. All remaining surfaces inside the elbow joint are covered by a thin, smooth tissue called synovial membrane. This membrane produces a little quantity of fluid in a healthy elbow, which lubricates the cartilage and removes practically all friction as you bend and rotate your arm. Muscles, ligaments, and tendons hold the elbow joint together.

Linked

Unlinked

Advantages

Ensure joint stability.
May be used in the presence of ligamentous insufficiency.
May be used in the presence of severe bone loss.
Better range of motion (soft-tissue release and non-anatomic implantation).

Increased constrained may result in increased tension to the interface and higher risk of mechanical failure secondary to wear and/or loosening.
More extensive canal invasion, potentially complicating revision surgery.
Cannot be used as hemiarthroplasty.
Component linking may make implantation more difficult. Possible failure of the linking mechanism.

Disadvantages

Less constrained implants may be associated with a lower risk of wear, loosening and osteolysis.
Less bony-invasive, which may be beneficial if revision or resection are required.
Some anatomic humeral components may be used as hemiarthroplasty.

Most require more accurate component positioning in order to ensure proper articular tracking.
It is possible to subluxate or dislocate the joint.
Difficult to use when there is the need to compensate for bone loss or ligamentous insufficiency
Limited ability for soft-tissue release or non-anatomic implant positioning in patients with stiffness.

	Linked	Unlinked
Advantages	Ensure joint stability. May be used in the presence of ligamentous insufficiency. May be used in the presence of severe bone loss. Better range of motion (soft-tissue release and non-anatomic implantation).	Increased constrained may result in increased tension to the interface and higher risk of mechanical failure secondary to wear and/or loosening. More extensive canal invasion, potentially complicating revision surgery. Cannot be used as hemiarthroplasty. Component linking may make implantation more difficult. Possible failure of the linking mechanism.
Disadvantages	Less constrained implants may be associated with a lower risk of wear, loosening and osteolysis. Less bony-invasive, which may be beneficial if revision or resection are required. Some anatomic humeral components may be used as hemiarthroplasty.	Most require more accurate component positioning in order to ensure proper articular tracking. It is possible to subluxate or dislocate the joint. Difficult to use when there is the need to compensate for bone loss or ligamentous insufficiency Limited ability for soft-tissue release or non-anatomic implant positioning in patients with stiffness.