Abstract:

Objective · To evaluate the early stage postoperative clinical efficacy of total elbow arthroplasty with customized constrained elbow prosthesis for the treatment of refractory destructive elbow diseases and analyze technical essentials of the operation. Methods · From Dec. 2009 to Jun. 2015, eight patients with refractory destructive elbow diseases underwent the total elbow arthroplasty with customized constrained elbow prosthesis (histiocytosarcoma with pathological fracture, malignant peripheral nerve sheath tumor, giant cell tumor, fibrous dysplasia, fibrous dysplasia with secondary aneurysmal bone cyst, villonodular synovitis, chronic synovitis, and hemophilic arthropathy with pathological fracture, one each). Preoperative Mayo Elbow Performance Index scores were <60 points in 6 patients, 60-74 points in 1 patient, and 75-89 points in 1 patient. The elbow posterior approach and ulnar nerve subcutaneous anterior transposition were performed and all patients achieved normal extension and flexion after arthroplasty. The extension and flexion exercise began 2 weeks after operation. The clinical efficacy and radiographic changes were evaluated. Results · The immediate postoperative radiographic evaluation showed no prosthesis handle pull-through failure, proper bone cement, stable prostheses, no infection, and no vessel and radial nerve injuries. The cubital nerve numb was seen in one patient and recovered after 2 weeks. This patient also had elbow instability after operation. The average follow-up period was 21.6 months. Mayo Elbow Performance Index scores during follow-up were 60-74 points in 1 patient, 75-89 points in 2 patients, and >90 in 5 patients. The radiographic evaluation showed that all prostheses were in position without looseness or fracture. The subjective satisfaction of patients was high. Conclusion · The total elbow arthroplasty with customized constrained elbow prosthesis is a reliable approach to treat refractory destructive elbow diseases. The technical essentials are ulnar and radius nerve protection, total resection of lesions, and ulnar prosthesis design. The prosthesis installation skill is a key point for avoiding complications.

Key words: elbow joint, bone neoplasms, elbow prosthesis, artificial joint