Abstract
Background
Recovery of elbow function is a challenging problem following resection arthroplasty after failure of total elbow prosthesis. The objective of this study is to evaluate long term functional outcome in a series of such patients.
Materials and Methods
Nineteen patients with twenty elbows who had failed total elbow arthroplasty (TEA) following the use of Baksi total elbow prosthesis needed removal of prosthesis during the period from 1978 to 2003. As two patients were lost to followup, 17 patients with 18 elbows (bilateral in one) were included in this study with a mean age of 44.3 years. Nine cases had uncontrolled infection, seven cases of aseptic loosening including one occurred after TEA for bilateral postburns ankylosis, and two had broken humeral stems. After removal of the prosthesis and its adjacent surrounding bone cement, the cut ends of humerus and ulna were approximated with number 5 Ethibond suture. Postoperatively, the elbow was immobilized in a plaster slab in 110° elbow flexion for 6 weeks followed by physiotherapy. The patients were evaluated for 15–19.4 (mean 16.3) years where functional results were compared at 10 years and 15 years following resection arthroplasty.
Results
The resected elbow initially remained flail but gradually regained stability, especially in the sagittal plane. Both the groups showed overall improvement from preoperative Mayo Elbow Performance Score (MEPS) 26.5 to postoperative mean MEPS at 10 years (69.6) and at 15 years (70) (P = 0.001). Postoperative mean DASH score was 36.62 at 10 years’ and 36.38 at 15 years’ followup, suggesting persistence of function of resected elbow in the passage of time. The results were good in 9 (50%), fair in 7 (38.8%), and poor in 2 (11.1%) patients. None had recurrence of infection. Transient ulnar nerve palsy was seen in three patients. Postoperatively, power of Biceps recovered up to Medical Research Council grade 4 and Triceps 2–3.
Conclusion
Resection arthroplasty of elbow provided acceptable functional recovery in our series of patients with failed elbow prosthesis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Little CP, Graham AJ, Carr AJ. Total elbow arthroplasty: A systematic review of the literature in the English language until the end of 2003. J Bone Joint Surg Br 2005;87:437–44.
Throckmorton T, Zarkadas P, Sanchez-Sotelo J, Morrey B. Failure patterns after linked semiconstrained total elbow arthroplasty for posttraumatic arthritis. J Bone Joint Surg Am 2010;92:1432–41.
Morrey BF, Bryan RS. Infection after total elbow arthroplasty. J Bone Joint Surg Am 1983;65:330–8.
Wolfe SW, Figgie MP, Inglis AE, Bohn WW, Ranawat CS. Management of infection about total elbow prostheses. J Bone Joint Surg Am 1990;72:198–212.
Yamaguchi K, Adams RA, Morrey BF. Infection after total elbow arthroplasty. J Bone Joint Surg Am 1998;80:481–91.
Baksi DP. Sloppy hinge prosthetic elbow replacement for posttraumatic ankylosis or instability. J Bone Joint Surg Br 1998;80:614–9.
Morrey BF, Bryan RS. Revision total elbow arthroplasty. J Bone Joint Surg Am 1987;69:523–32.
Morrey BF, editor. The Elbow and Its Disorders. 3rd ed. Philadelphia: W. B. Saunders; 2000. p. 685–700.
Razza F, Peretti GM, Macias G, Lastroni G. Resection arthroplasty as alternative procedure for the stiff elbow. Minerva Orthop Traumatol 2001;52:73–80.
Zarkadas PC, Cass B, Throckmorton T, Adams R, Sanchez-Sotelo J, Morrey BF. Long term outcome of resection arthroplasty for the failed total elbow arthroplasty. J Bone Joint Surg Am 2010;92:2576–82.
Baksi DP. Total replacement of the elbow joint. Indian J Orthop 1980;14:129–42.
Baksi DP. Studies on Physical Properties of a Newly Designed Elbow Prosthesis and Clinical Evaluation After Its Transplantation. Ph D Thesis. 1984 University of Calcutta; 1984. p. 1–186.
Baksi DP. Evaluation of physical properties of author’s elbow prosthesis with the help of a newly designed elbow joint simulator. Indian J Orthop 1989;23:61–9.
Baksi DP. Result of Baksi sloppy hinge compared to rigid hinge elbow arthoplasty. Indian J Orthop 1995;30:1–11.
Baksi DP, Pal AK, Chatterjee ND, Baksi D. Prosthetic replacement of elbow in postburn bony ankylosis: Long term results. Int Orthop 2009;33:1001–7.
Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The Elbow and Its Disorder. 2nd ed. Philadelphia: W. B. Saunders; 1993. p. 74–83.
Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. The upper extremity collaborative group (UECG) Am J Ind Med 1996;29:602–8.
Dee R. Reconstructive surgery following total elbow endoprosthesis. Clin Orthop Relat Res 1982;(170):196–203.
Figgie MP, Inglis AE, Mow CS, Wolfe SW, Sculco TP, Figgie HE 3rd. Results of reconstruction for failed total elbow arthroplasty. Clin Orthop Relat Res 1990;(253):123–32.
Kita M. Arthroplasty of the elbow using J-K membrane. An analysis of 31 cases. Acta Orthop Scand 1977;48:450–5.
Knight RA, Van zandt IL. Arthroplasty of the elbow; an end-result study. J Bone Joint Surg Am 1952;24 A: 610–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pal, A.K., Baksi, D., Mondal, R. et al. Evaluation of Functional Outcome of Elbows after Resection Arthroplasty of Failed Total Elbow Replacement. JOIO 53, 776–784 (2019). https://doi.org/10.4103/ortho.IJOrtho_506_18
Published:
Issue Date:
DOI: https://doi.org/10.4103/ortho.IJOrtho_506_18