Total Elbow Arthroplasty: Why and How.

Abstract

Elbow arthroplasty is a relatively infrequent orthopaedic procedure that can be performed in multiple ways according to the type of prosthesis that is used and the needs of the individual patient. Place the patient in the lateral decubitus position or in the supine position with the arm draped, allowing for easy manipulation of the elbow during the procedure. Palpate and mark the local osseous landmarks, ulnar nerve, and incision, and then make a posterior incision to allow 360° access to the elbow joint as well as to allow decompression or transposition of the ulnar nerve. Perform the superficial approach, including a decompression of the ulnar nerve, and properly visualize the triceps tendon attachment on the proximal part of the ulna and both epicondyles. Mobilize the triceps to allow visualization of the articular surfaces of the ulna, humerus, and radius, while taking care to protect the ulnar nerve. Prepare the humerus and ulna in conformance with the technique that is described for the prosthesis and take care to restore the anatomical flexion-extension axis of the elbow. When all trial components are in place, reduce the joint to test the stability of the elbow. When all of the definitive components of the total elbow arthroplasty are in place, close the surgical wound in layers as the anatomy is restored. After surgery, a wound dressing is applied and physical rehabilitation is started to maximize the functional outcome. In our study of the mid-term results of a convertible total elbow arthroplasty, based on 58 elbow arthroplasties, patients had significant improvement in range of movement, function, and pain at 6 months postoperatively⁸.