Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty

Between 1986 and 1994, 13 patients with mobile painful arthritic elbows wer e treated by distraction interposition arthroplasty using fascia lata, The mean period of follow-up was 63 months, An elbow distractor/fixator was app lied for three to four weeks to separate the articular surfaces and to prot ect the fascial graft, Nine of the 13 patients (69%) had satisfactory relief from pain; eight (62% ) had an excellent or good result by the objective criteria of the Mayo Elb ow Performance score. Four have required revision to total elbow arthroplas ty at a mean of 30 months with good results to date. Instability of the elbow, both before and after surgery, was found to be as sociated with unsatisfactory results. The rate of success when the procedur e was performed for inflammatory arthritis was similar to that for post-tra umatic arthritis, about 67%. Eight complications occurred in six patients, all in the group with post-traumatic arthritis. Two of these required furth er surgical procedures such as transposition of the ulnar nerve or repair o f hernia of the fascia lata. Although less reliable than prosthetic replacement, distraction interpositi on arthroplasty is a useful option in the treatment of young, high-demand p atients with arthritis of the elbow. It is rarely indicated in the presence of generalised inflammatory arthritis, but mag be of value in those patien ts in whom the disease is limited primarily to the elbow.