Article
Complications of semi constrained total elbow arthroplasty in non-rheumatoid patients: lessons learned with application in an active population with biomechanically restrictive implants
Search Medline for
Authors
Published: | February 6, 2020 |
---|
Outline
Text
Objectives: Expanded application of TEA has been reported in patients with osteoarthritis, posttraumatic arthritis and in cases of severe trauma precluding fracture reconstruction, with reports of successful outcomes. Such patients, however, tend to be younger, more active, and therefore potentially place higher demands and stresses on current less than physiologic implants. We reviewed our institute's experience in non-rheumatoid patients with the hypothesis of finding poor compliance with activity limitations and a high rate of complications
Methods: Over a ten-year period, the authors have implanted 64 linked total elbow arthroplasties in 64 patients (age 38-84, mean 58 years; 39 men, 29 women) with osteo or post-traumatic arthritis, or unreconstructable fractures. Initial results at two years demonstrated satisfactory results with a high satisfaction rate and a low complication rate with four early reoperations (6.4%), comparable to other published reports. But longer term follow-up at 4-10 years has demonstrated a higher implant related complication rate. Reoperation was required in an additional 21 patients (32.8%). Compliance with physical restrictions was minimal.
Results: Total elbow arthroplasty has added immensely to our armormentarium of tools for the treatment of rheumatoid arthritis, especially in low demand patients who lead a sedentary lifestyle. Clearly, as indications for application of this technique have expanded to include a more active patient population, implant stresses and resultant failure rates have been found to increase with longer-term follow-up. These findings suggest a need to rethink implant design to become more responsive to physiologic loads demanded in more active patients and to counsel future patients as well as existing patients with current implants regarding the limits and potential failure of existing implant designs.
Conclusion: Future implant designs should incorporate more anatomic load sharing characteristics to accommodate the demands of this more active population of patients.