SEMICONSTRAINED TOTAL ELBOW REPLACEMENT FOR THE TREATMENT OF POSTTRAUMATIC OSTEOARTHROSIS

Forty-one consecutive patients were managed for post-traumatic osteoar throsis or dysfunction of the elbow with use of a non-customized semi- constrained Coonrad-Morrey total elbow prosthesis. The average age at the time of the operation was fifty-seven Sears (range, thirty-two to eighty-two years). The patients were followed for an average of five y ears and eight months (range, two to twelve years). Radiographs were m ade at least two years postoperatively (average, five years and one mo nth; range, two to twelve years) for thirty-nine of the forty-one pati ents. According to the Mayo elbow performance score, sixteen patients (39 per cent) had an excellent result, eighteen (44 per cent) had a go od result, five (12 per cent) had a fair result, and two (5 per cent) had a poor result. Thirty-six (95 per cent) of the thirty-eight patien ts who had a functioning implant at the time of follow-up considered t he outcome to be satisfactory. Preoperatively, thirty-seven patients ( 90 per cent) had moderate or severe pain; postoperatively, thirty (73 per cent) had no or only mild discomfort. Motion improved from an aver age are of flexion of 40 to 118 degrees preoperatively to an average a re of flexion of 27 to 131 degrees postoperatively. All thirty-eight f unctioning implants rendered the elbow stable. Eleven patients (27 per cent) had a major complication. Nine of them (22 per cent of the seri es) needed an additional operation. There was no aseptic loosening, an d most of the complications were primarily due to so-called mechanical failure. The ulnar component fractured in five patients (12 per cent) , and the polyethylene bushings wore out in two (5 per cent). These co mplications were attributed principally to the performance of strenuou s physical labor, such as lifting more than ten kilograms on a regular basis, against the advice of the surgeon; excessive preoperative defo rmity of the joint; or an unstable traumatic injury. Two patients (5 p er cent) had an infection. Semiconstrained joint replacement of the el bow can be a reliable form of treatment, anti frequently is the only v iable option, for the difficult problems encountered with post-traumat ic destruction of a joint. Restoration of function, relief of pain, an d patient satisfaction can be achieved even when a patient is less tha n sixty years old if that patient has low demands and is. low level of activity However, the mechanical failures underscore the fact that th is procedure is relatively contraindicated in patients who anticipate strenuous physical activity or who are not expected to comply with the postoperative protocol. This observation reflects the tendency for in creased and excessive use of a previously functionless joint, after it has been rendered stable and pain-free, to lead to mechanical failure .