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P. M. Rozing - One of the best experts on this subject based on the ideXlab platform.
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Outcome of revision surgery for failed primary Souter-Strathclyde total Elbow Prosthesis
Journal of Shoulder and Elbow Surgery, 2006Co-Authors: J. C. T. Van Der Lugt, P. M. RozingAbstract:Total Elbow arthroplasty is used for the treatment of the painful, destroyed Elbow joint. With the increase in Elbow replacement surgery in recent years, the number of revision surgeries will also increase. At our center, 236 primary Souter-Strathclyde total Elbow prostheses have been placed. Twenty-four of these have been revised and were followed up for a mean of 74 months (range, 12–165 months). The postoperative clinical outcome after revision surgery can approximate the outcome after primary Elbow replacement. Unfortunately, 8 Elbows needed to be re-revised, 7 Elbow prostheses loosened, and we had 1 early dislocation during follow-up. Three of the eight re-revised Elbows had a third revision. Two other patients had a resection arthroplasty because of deep infection after the first revision. After 5 years, 73.8% of the revised Elbow prostheses were still in situ. The lack of other satisfactory treatment options, combined with the satisfactory clinical results, justify revision surgery of Elbow prostheses. The absence of intraoperative fracture during removal of the relatively small standard components and the availability of long-stemmed revision components, which facilitate fixation in the impaired bone, both support our preference for the Souter-Strathclyde Prosthesis.
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Primary Souter-Strathclyde total Elbow Prosthesis in rheumatoid arthritis.
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:BACKGROUND: Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.
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Primary Souter-Strathclyde Total Elbow Prosthesis in Rheumatoid Arthritis
JBJS Essential Surgical Techniques, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concer
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Primary Souter-Strathclyde total Elbow Prosthesis in rheumatoid arthritis. Surgical technique.
The Journal of bone and joint surgery. American volume, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.
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Systematic review of primary total Elbow prostheses used for the rheumatoid Elbow
Clinical Rheumatology, 2004Co-Authors: J. C. T. Van Der Lugt, P. M. RozingAbstract:Total Elbow Prosthesis (TEP) has been shown to be a viable option for treatment of the rheumatoid Elbow. Many types of TEP have been studied, but the heterogeneity of the studies makes most conclusions subject to discussion. The aim of this systematic review is to show the differences between the most commonly used TEP for the destroyed rheumatoid Elbow. After a search in Pubmed (NLM, Bethesda, USA) the senior author selected eight frequently used TEP: the Capitellocondylar, Coonrad-Morrey, GSB III, Kudo, Liverpool, Norway, Roper–Tuke and Souter–Strathclyde. For inclusion studies we arbitrarily formulated nine criteria , after which clearly adverse events were defined for comparison purposes. The Capitellocondylar and Souter–Strathclyde prostheses are the most-studied treatments for replacing the rheumatoid Elbow. In contrast to the Capitellocondylar, the Souter–Strathclyde Prosthesis showed higher loosening rates but implemented modifications of the design have reduced these rates in recent studies. Nevertheless, in relation to most other joint replacements in rheumatoid patients, all TEP still have higher complication rates. For this reason an Elbow Prosthesis may just be warranted in seriously disabled patients.
J. C. T. Van Der Lugt - One of the best experts on this subject based on the ideXlab platform.
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Outcome of revision surgery for failed primary Souter-Strathclyde total Elbow Prosthesis
Journal of Shoulder and Elbow Surgery, 2006Co-Authors: J. C. T. Van Der Lugt, P. M. RozingAbstract:Total Elbow arthroplasty is used for the treatment of the painful, destroyed Elbow joint. With the increase in Elbow replacement surgery in recent years, the number of revision surgeries will also increase. At our center, 236 primary Souter-Strathclyde total Elbow prostheses have been placed. Twenty-four of these have been revised and were followed up for a mean of 74 months (range, 12–165 months). The postoperative clinical outcome after revision surgery can approximate the outcome after primary Elbow replacement. Unfortunately, 8 Elbows needed to be re-revised, 7 Elbow prostheses loosened, and we had 1 early dislocation during follow-up. Three of the eight re-revised Elbows had a third revision. Two other patients had a resection arthroplasty because of deep infection after the first revision. After 5 years, 73.8% of the revised Elbow prostheses were still in situ. The lack of other satisfactory treatment options, combined with the satisfactory clinical results, justify revision surgery of Elbow prostheses. The absence of intraoperative fracture during removal of the relatively small standard components and the availability of long-stemmed revision components, which facilitate fixation in the impaired bone, both support our preference for the Souter-Strathclyde Prosthesis.
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Primary Souter-Strathclyde total Elbow Prosthesis in rheumatoid arthritis.
Journal of Bone and Joint Surgery American Volume, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:BACKGROUND: Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.
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Primary Souter-Strathclyde Total Elbow Prosthesis in Rheumatoid Arthritis
JBJS Essential Surgical Techniques, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concer
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Primary Souter-Strathclyde total Elbow Prosthesis in rheumatoid arthritis. Surgical technique.
The Journal of bone and joint surgery. American volume, 2005Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:Total Elbow arthroplasty is a well-established treatment for the painful Elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total Elbow Prosthesis. Between June 1982 and December 2000, 204 primary total Elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. Six of the 204 Elbows had pain at rest at the time of the latest follow-up. Ten patients (ten Elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four Elbows had revision of the total Elbow Prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the Prosthesis (one). One Prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. Total Elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total Elbow Prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.
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Influence of previous open synovectomy on the outcome of Souter-Strathclyde total Elbow Prosthesis
Rheumatology, 2004Co-Authors: J. C. T. Van Der Lugt, Ronald B. Geskus, P. M. RozingAbstract:Objectives. Open synovectomy of the Elbow joint is often performed in early stages of rheumatoid arthritis. Because of poor long-term results after synovectomy, insertion of a total Elbow Prosthesis is commonly used as a secondary procedure. The aim of this study is to evaluate the influence of previous synovectomy on the outcome after placement of a total Elbow Prosthesis. Methods. We inserted 204 primary Souter-Strathclyde total Elbow prostheses for rheumatoid arthritis. Two groups could be distinguished: group A with previous synovectomy 3.9 yr (mean) before the Elbow replacement (n = 33) and group B without previous synovectomy (n = 171). The mean follow-up was 5.8 yr for group A and 6.3 yr for group B. All patients were assessed clinically and radiologically before the operation, 1 and 2 years later and then at regular intervals. The effect of previous synovectomy was analysed via a Cox model and a generalized linear mixed model for binomial data with multivariate normal random effects. Results. No statistically significant effect of previous synovectomy on pain, function or complaints of the ulnar nerve could be found post-operatively. The post-operative flexion was significantly higher in group B than in group A. The complication-rates were similar for both groups. The overall survival rate for respectively group A and B with revision as endpoint was 66.9% (S.E. 13.4) versus 79.6 (S.E. 4.3) after 10 yr. Conclusions. Previous synovectomy does not diminish the outcome after total Elbow Prosthesis in this series and could therefore be considered in early, painful stages of rheumatoid destruction of the Elbow joint.
Francesco Pogliacomi - One of the best experts on this subject based on the ideXlab platform.
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Linked semi-constrained total Elbow Prosthesis in chronic arthritis: results of 18 cases
MUSCULOSKELETAL SURGERY, 2010Co-Authors: Maurizio Corradi, Marco Frattini, Bruno Panno, Silvio Tocco, Francesco PogliacomiAbstract:During the second half of the 1900s, total Elbow joint replacement began its ascent. Since then, many prosthetic models have been used. The main objective of Elbow joint replacement in arthritic diseases is to decrease pain, increase joint stability and improve overall range of motion. In this study, 18 patients affected with Elbow arthritis were treated with the Coonrad-Morrey and Discovery total Elbow prostheses. All patients were assessed clinically before and after surgery using the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire and through radiograph analysis. Excellent and good results were observed in 88.9% of the cases at a mean follow-up of 5 years. Significant statistical differences in all parameters between preoperative and final follow-up values confirm the efficacy of these devices.
Bernard F. Morrey - One of the best experts on this subject based on the ideXlab platform.
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The Pritchard ERS total Elbow Prosthesis: lessons to be learned from failure.
Journal of Shoulder and Elbow Surgery, 2009Co-Authors: Roger Van Riet, Bernard F. Morrey, Shawn W. O'driscollAbstract:Background Documentation of the long-term effectiveness of 3-part unlinked Elbow replacement is limited. The value of replacing the radial humeral articulation has not been addressed to any extent in the currently available literature. Materials A retrospective study of patient charts and radiographs of 37 patients receiving 46 primary Pritchard ERS TM arthroplasties between 1983 and 1992 were reviewed. Thirty-two implants (70%) failed after an average of 83 months (range, 0-198). Causes of failure were analyzed in detail. Results Kaplan Meier survivor analysis showed a 10-year survival of 54% (confidence interval: 40-71%). Main reasons for failure were instability, wear, and loosening. Immediate postoperative radiographs showed ulnohumeral malposition (valgus or varus) in 19 Elbows, which directly correlated to subsequent failure. While this design has proven to be unsuccessful, it does document the need for precise technique and highlights the issue of replacing the radio/capitellar joint in future designs deserves further study. Conclusion An explanation of these disappointing outcomes resides both in an inadequate design and a poorly understood and executed surgical technique. The value of refined instrumentation to allow accurate and reproducible component implantation and soft tissue balancing is highlighted. These considerations are particularly relevant if the radial head component is to be used. Level of evidence Level IV, Case Series, Treatment Study.
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Reimplantation of a total Elbow Prosthesis following resection arthroplasty for infection.
The Journal of Bone and Joint Surgery-American Volume, 2008Co-Authors: Emilie V. Cheung, Robert A. Adams, Bernard F. MorreyAbstract:Background: The best approach for treatment of infection after total Elbow arthroplasty is not clearly defined. The purpose of this study was to report our experience with reimplantation of a total Elbow Prosthesis following a prior resection arthroplasty to treat infection. Methods: Between 1976 and 2003 at our institution, twenty-nine patients were treated with reimplantation of a total Elbow Prosthesis after a prior resection arthroplasty following a deep periprosthetic infection. Eleven of the twenty-nine patients had had at least one procedure performed on the Elbow prior to the primary arthroplasty. The mean time interval between the resection arthroplasty and the reimplantation was 72.5 weeks. Patients were followed for an average of 7.4 years after the reimplantation. All patients were assessed clinically, and their medical records were retrospectively reviewed. Results: The mean total Mayo Elbow Performance Score (MEPS) was 35.5 points (range, 15 to 60 points) before the reimplantation and 66.3 points (range, 20 to 100 points) postoperatively (p < 0.001). The most common infecting organism was Staphylococcus epidermidis, which was present in thirteen (45%) of the twenty-nine Elbows, followed by methicillin-sensitive Staphylococcus aureus, which was present in seven (24%). The infection was not eradicated in eight Elbows (28%). Conclusions: Reimplantation of a total Elbow Prosthesis after a prior resection arthroplasty is a reasonable option for the treatment of infection. Improvement in function can be expected in most patients. However, the chance of the infection recurring and requiring additional revision surgery is high. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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Kinematics and laxity of the Souter-Strathclyde total Elbow Prosthesis
Journal of Shoulder and Elbow Surgery, 2000Co-Authors: Alberto G. Schneeberger, Shawn W. O'driscoll, Graham J.w. King, Seok Whan Song, Bernard F. MorreyAbstract:The motion pattern and laxity of 8 cadaveric Elbows were recorded with a 3-dimensional electromagnetic tracking device before and after the Souter-Strathclyde total Elbow Prosthesis was implanted. The Souter-Strathclyde Prosthesis replicates the valgus-varus motion pattern of the intact Elbow but causes a significant internal rotation of the ulnar shaft of 8.9 degrees +/- 4.1 degrees (P < .0005) at 110 degrees of Elbow flexion. One of the reasons for this unphysiological motion pattern is positioning of the humeral component in a mean of 5.4 degrees +/- 6.4 degrees of external rotation compared with the intact Elbow (P = .05). This positioning is related to the design of this device. The Souter-Strathclyde Elbow Prosthesis has a mean maximum valgus-varus laxity of 6.5 degrees +/- 1.5 degrees compared with 4.3 degrees +/- 2.3 degrees for the intact Elbow (P = .004). This implant is more constrained than previously tested devices, which may explain its relatively higher loosening rate.
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Motion and laxity of the capitellocondylar total Elbow Prosthesis.
The Journal of Bone & Joint Surgery, 1994Co-Authors: Graham J.w. King, Eiji Itoi, Glen L. Niebur, Bernard F. MorreyAbstract:The motion and laxity of the capitellocondylar unconstrained total Elbow Prosthesis were assessed, with use of an electromagnetic tracking device and stimulated muscle-loading, after implantation in seventeen cadaveric Elbows. The axis of motion of the Elbows with the capitellocondylar implants averaged 2.1 +/- 2.3 degrees more varus angulation than that of the intact Elbows. This difference may be attributed to the design of the implant, as the 5-degree-valgus humeral component used in this study has a smaller valgus inclination than the articular surface of the distal aspect of the humerus. Although the maximum valgus-varus laxity of the capitellocondylar Elbow prostheses was, on the average, 4.3 +/- 2.4 degrees greater than normal (with simulated muscle-loading), the data must be interpreted in light of the fact that this in vitro study did not allow for soft-tissue healing. The prosthetic components tracked well, and there were no dislocations or malarticulations provided that appropriate soft-tissue tensioning and positioning of the components had been achieved at the time of implantation. Sectioning of either the medial or the lateral collateral ligament resulted in gross instability of the joint after capitellocondylar arthroplasty. The ulnar attachment of the medial collateral ligament was found to be vulnerable to injury during the positioning of the ulnar component of this implant.
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In vitro stability of an unconstrained total Elbow Prosthesis: Influence of axial loading and joint flexion angle**
The Journal of Arthroplasty, 1993Co-Authors: Graham J.w. King, Shari J. Glauser, Andrew Westreich, Bernard F. MorreyAbstract:Total Elbow arthroplasty is often used to replace Elbow joints that have been severely damaged by arthritis or trauma. A great disparity of designs exists, however, in currently available Elbow prostheses. This study evaluated the intrinsic stability of one popular resurfacing implant, the Capitellocondylar (Johnson and Johnson Orthopaedics, Inc., New Brunswick, NJ) total Elbow. The in vitro response of this unconstrained Prosthesis to valgus-varus and supination-pronation loading was investigated using a materials testing machine. The influence of compressive loading and flexion angle on the intrinsic stability of the Prosthesis was studied. The Capitellocondylar Prosthesis was found to have little intrinsic constraint, relying on external forces for component stabilization. Dislocations were common at 111 N of compressive loading, while larger loads progressively stabilized the Prosthesis. Joint flexion angle had little influence on the intrinsic constraint of the implant except to increase varus stability at lower flexion angles. The Capitellocondylar total Elbow Prosthesis, as designed by F. C. Ewald, behaves as an unconstrained implant. Adequate soft tissue supports, which are properly balanced to provide controlled loading, are essential to prevent instability of this arthroplasty.
Shawn W. O'driscoll - One of the best experts on this subject based on the ideXlab platform.
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The Pritchard ERS total Elbow Prosthesis: lessons to be learned from failure.
Journal of Shoulder and Elbow Surgery, 2009Co-Authors: Roger Van Riet, Bernard F. Morrey, Shawn W. O'driscollAbstract:Background Documentation of the long-term effectiveness of 3-part unlinked Elbow replacement is limited. The value of replacing the radial humeral articulation has not been addressed to any extent in the currently available literature. Materials A retrospective study of patient charts and radiographs of 37 patients receiving 46 primary Pritchard ERS TM arthroplasties between 1983 and 1992 were reviewed. Thirty-two implants (70%) failed after an average of 83 months (range, 0-198). Causes of failure were analyzed in detail. Results Kaplan Meier survivor analysis showed a 10-year survival of 54% (confidence interval: 40-71%). Main reasons for failure were instability, wear, and loosening. Immediate postoperative radiographs showed ulnohumeral malposition (valgus or varus) in 19 Elbows, which directly correlated to subsequent failure. While this design has proven to be unsuccessful, it does document the need for precise technique and highlights the issue of replacing the radio/capitellar joint in future designs deserves further study. Conclusion An explanation of these disappointing outcomes resides both in an inadequate design and a poorly understood and executed surgical technique. The value of refined instrumentation to allow accurate and reproducible component implantation and soft tissue balancing is highlighted. These considerations are particularly relevant if the radial head component is to be used. Level of evidence Level IV, Case Series, Treatment Study.
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Total Elbow Prosthesis loosening caused by ulnar component pistoning.
The Journal of Bone & Joint Surgery, 2007Co-Authors: Emilie V. Cheung, Shawn W. O'driscollAbstract:Background: Linked semiconstrained total Elbow prostheses have been used successfully but may be at higher risk for implant loosening than unlinked implants are. The purpose of the present report was to describe a previously unreported and potentially preventable cause of mechanical loosening of the ulnar component of a linked total Elbow Prosthesis. Methods: A series of ten patients who had painful pistoning of the polymethylmethacrylate-coated ulnar component of a Coonrad-Morrey linked total Elbow Prosthesis were evaluated clinically and radiographically. Results: All ten patients complained of Elbow pain, and eight had a distinct sensation of the ulnar component moving within the ulna. Six patients either complained of squeaking within the Elbow or could demonstrate squeaking on examination. Four patients had a complete radiolucent line around the ulnar component or the cement mantle, and six had an incomplete line around the ulnar component. Six patients had a radiolucent gap between the cement and the tip of the ulnar Prosthesis. Two patients had proximal migration of the ulnar component within the cement mantle on lateral flexion radiographs. Three patients had anterior impingement, such as between the anterior flange of the humeral implant and a prominent coronoid process, on lateral flexion radiographs. At the time of revision arthroplasty, all ten patients were found to have a loose ulnar component, which was successfully revised with or without impaction grafting. At the time of the most recent follow-up, nine of the ten ulnar components were intact and stable. Three patients required an additional reoperation: one required triceps repair, one required revision of a loose humeral component, and one required a revision total Elbow arthroplasty. Conclusions: Pistoning of the ulnar component in the cement mantle leading to failure by means of a pullout mechanism can occur in association with the Coonrad-Morrey total Elbow Prosthesis with a polymethylmethacrylate-precoated ulnar component. To prevent this problem following any total Elbow arthroplasty, the surgeon should check for anterior impingement intraoperatively by ensuring that there is no contact between the anterior flange and a prominent coronoid process or the cement and that no distraction of the trial ulnar component from the ulna occurs with passive Elbow flexion. This condition also can be avoided by ensuring that the ulnar component is not inserted too far distally. This mechanism of failure should be considered when future total Elbow arthroplasty implants are designed. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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Role of collateral ligaments in the GSB-linked total Elbow Prosthesis.
Journal of Shoulder and Elbow Surgery, 2001Co-Authors: Daniel B. Herren, Shawn W. O'driscollAbstract:Abstract The GSB III Elbow Prosthesis is a loose-hinged type of Elbow implant. The introduction of such hinged Elbow arthroplasty expanded the indications for Elbow replacement to patients with more deficient bone and ligaments. The purpose of this study was to compare the kinematics and stability of the GSB III Elbow Prosthesis with that of the normal Elbow and to investigate the role of the collateral ligaments in the kinematics and the stability of the GSB III total Elbow Prosthesis in an in vitro model. The results could show a semiconstrained kinematic pattern of the GSB III implant. The mean laxity for varus/valgus stress of the implant without collateral ligament support was significantly greater for all flexion angles when compared with intact Elbows (mean, 12.7° versus 5.4°) and with Elbows treated with a standard implantation technique (mean, 9.5°). The release of the collateral ligaments increased the already observed varus shift after standard implantation of a GSB III Elbow Prosthesis. The laxity measured without collateral ligaments during loaded movement reached the maximum varus/valgus laxity of the GSB III Prosthesis of 12° degrees. The study confirms the role of the collateral ligaments in stabilizing the GSB III Elbow Prosthesis. Missing collateral ligaments may overload the implant-cement-bone interface and may be one factor contributing to early aseptic loosening of this device. (J Shoulder Elbow Surg 2001;10:260-4.)
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Kinematics and laxity of the Souter-Strathclyde total Elbow Prosthesis
Journal of Shoulder and Elbow Surgery, 2000Co-Authors: Alberto G. Schneeberger, Shawn W. O'driscoll, Graham J.w. King, Seok Whan Song, Bernard F. MorreyAbstract:The motion pattern and laxity of 8 cadaveric Elbows were recorded with a 3-dimensional electromagnetic tracking device before and after the Souter-Strathclyde total Elbow Prosthesis was implanted. The Souter-Strathclyde Prosthesis replicates the valgus-varus motion pattern of the intact Elbow but causes a significant internal rotation of the ulnar shaft of 8.9 degrees +/- 4.1 degrees (P < .0005) at 110 degrees of Elbow flexion. One of the reasons for this unphysiological motion pattern is positioning of the humeral component in a mean of 5.4 degrees +/- 6.4 degrees of external rotation compared with the intact Elbow (P = .05). This positioning is related to the design of this device. The Souter-Strathclyde Elbow Prosthesis has a mean maximum valgus-varus laxity of 6.5 degrees +/- 1.5 degrees compared with 4.3 degrees +/- 2.3 degrees for the intact Elbow (P = .004). This implant is more constrained than previously tested devices, which may explain its relatively higher loosening rate.
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Latitude Convertible Total Elbow Prosthesis
Treatment of Elbow Lesions, 1Co-Authors: Graham J.w. King, Ken Yamaguchi, Shawn W. O'driscollAbstract:Severe arthritis of the Elbow was historically managed with resection or interposition arthroplasty. Dee was the first to report the use of total Elbow arthroplasty in the English literature [1]. The fixedhinge design was fully constrained and transferred stress directly to the prosthetic interface resulting in high rates of aseptic loosening and early failures. A greater understanding of Elbow anatomy and kinematics has led to advances in prosthetic design and surgical technique.