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Bernhard F Morrey - One of the best experts on this subject based on the ideXlab platform.
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triceps insufficiency after the treatment of deep infection following total Elbow Replacement
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Thomas R. Duquin, Joaquin Sanchezsotelo, Dirk R Larson, Jon A Jacobson, Cathy D Schleck, Bernhard F MorreyAbstract:Treatment of an infected total Elbow Replacement (TER) is often successful in eradicating or suppressing the infection. However, the extensor mechanism may be compromised by both the infection and the surgery. The goal of this study was to assess triceps function in patients treated for deep infection complicating a TER. Between 1976 and 2007 a total of 217 TERs in 207 patients were treated for infection of a TER at our institution. Superficial infections and those that underwent resection arthroplasty were excluded, leaving 93 TERs. Triceps function was assessed by examination and a questionnaire. Outcome was measured using the Mayo Elbow Performance Score (MEPS). Triceps weakness was identified in 51 TERs (49 patients, 55%). At a mean follow-up of five years (0.8 to 34), the extensor mechanism was intact in 13 patients, with the remaining 38 having bone or soft-tissue loss. The mean MEPS was 70 points (5 to 100), with a mean functional score of 18 (0 to 25) of a possible 25 points. Infection following TER can often be eradicated; however, triceps weakness occurs in more than half of the patients and may represent a major functional problem. Cite this article: Bone Joint J 2014;96-B:82–7.
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revision of total Elbow Replacement by exchange cementing
Journal of Bone and Joint Surgery-british Volume, 2012Co-Authors: A A Malone, Robert A Adams, J S Sanchez, Bernhard F MorreyAbstract:We report the effectiveness of revision of total Elbow Replacement by re-cementing. Between 1982 and 2004, 53 Elbows in 52 patients were treated with re-cementing of a total Elbow Replacement into part or all of the existing cement mantle or into the debrided host-bone interface, without the use of structural bone augmentation or a custom prosthesis. The original implant revision was still in situ and functional in 42 of 53 Elbows (79%) at a mean of 94.5 months (26 to 266) after surgery. In 31 of these 42 Elbows (74%) the Mayo Elbow Performance Score was good or excellent. Overall, of the 53 Elbows, 18 (34%) required re-operation, ten (19%) for loosening. A classification system was developed to identify those not suitable for revision by this technique, and using this we have showed that successful re-implantation is statistically correlated to properly addressing the bone deficiency for both the humeral (p = 0.005) and the ulnar (p = 0.039) components.
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total Elbow Replacement for the management of the ankylosed or fused Elbow
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: J P Peden, Bernhard F MorreyAbstract:This study reports our experience with total Elbow Replacement for fused Elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed Elbows were treated with a linked semi-constrained non-custom total Elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten Elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37° of extension to 118° of flexion was achieved. Outcomes were good or excellent for seven Elbows at final review. Ten patients felt better or much better after total Elbow Replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one Elbow following fracture of the ulnar component. Three patients developed a deep infection. Three Elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total Elbow Replacement for the ankylosed Elbow should be performed with caution. However, the outcome can be reliable in the long term and have a markedly positive impact on patient function and satisfaction. The high potential for complications must be considered. We consider total Elbow Replacement to be an acceptable procedure in selected patients with reasonable expectations.
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Total Elbow Replacement for the management of the ankylosed or fused Elbow
The Journal of bone and joint surgery. British volume, 2008Co-Authors: J P Peden, Bernhard F MorreyAbstract:This study reports our experience with total Elbow Replacement for fused Elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed Elbows were treated with a linked semi-constrained non-custom total Elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten Elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37 degrees of extension to 118 degrees of flexion was achieved. Outcomes were good or excellent for seven Elbows at final review. Ten patients felt better or much better after total Elbow Replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one Elbow following fracture of the ulnar component. Three patients developed a deep infection. Three Elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total Elbow Replacement for the ankylosed Elbow should be performed with caution. However, the outcome can be reliable in the long term and have a markedly positive impact on patient function and satisfaction. The high potential for complications must be considered. We consider total Elbow Replacement to be an acceptable procedure in selected patients with reasonable expectations.
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primare totale ellenbogenprothese zur versorgung distaler humerusfrakturen primary total Elbow Replacement for fractures of the distal humerus
Operative Orthopadie Und Traumatologie, 2005Co-Authors: Srinath Kamineni, Pol Maria Rommens, Bernhard F MorreyAbstract:Objective Achieving stability and pain-free function for osteoporotic intraarticular multifragmentary fractures of the distal humerus in elderly patients by primary total Elbow Replacement (TER).
Andrew Carr - One of the best experts on this subject based on the ideXlab platform.
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Elbow Replacement FOR RHEUMATOID ARTHRITIS: A SINGLE CENTRE,THREE IMPLANT COMPARATIVE SERIES
2018Co-Authors: Christopher Little, A. J. Graham, G Ionanides, Andrew CarrAbstract:A systematic review of the English language literature has suggested that the performance of linked and unlinked Elbow Replacement implants differ in terms of function, survival and mode of failure...
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Elbow Replacement FOR RHEUMATOID ARTHRITIS: A SINGLE CENTRE,THREE IMPLANT COMPARATIVE SERIES
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: Christopher Little, A. J. Graham, G Ionanides, Andrew CarrAbstract:A systematic review of the English language literature has suggested that the performance of linked and unlinked Elbow Replacement implants differ in terms of function, survival and mode of failure; however, in this review, only one comparative series using contemporary implants was identified. We have performed a cohort study of Kudo, Souter-Strathclyde and Coonrad-Morrey Elbow Replacements performed at a single centre by or under the direct supervision of a single Consultant shoulder and Elbow surgeon to see if these findings were reflected in clinical practice. The first forty implantations in patients with Rheumatoid arthritis for each device have been reviewed with respect to surgical complications, Elbow function and implant survival. The follow-up was shorter for the Coonrad-Morrey cohort. In terms of pain relief and range of motion, the performance of the implants was comparable. The mode of failure was different, with no dislocations/ instability seen with the linked Coonrad-Morrey implants. The loosening rate of the Coonrad-Morrey implants (both clinical and radiographic) was lower, albeit with a shorter follow-up period. The loosening rates seen in this series were higher than those previously reported in the English language literature. We conclude that the functional performance of the implants, at similar stages of the surgical learning curves, are similar in patients with Rheumatoid arthritis, but that use of a linked implant removes the risk of post-operative instability and may reduce the risk of the radiographic and clinical loosening.
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surgery for rheumatoid arthritis of the Elbow a comparison of radial head excision and synovectomy with total Elbow Replacement
Journal of Shoulder and Elbow Surgery, 1999Co-Authors: David A Woods, Nagui Gendi, Alastair G Mowat, Peter Burge, J.r. Williams, Andrew CarrAbstract:Abstract The results of total Elbow Replacement (TER) in 45 Elbows of 38 patients with rheumatoid arthritis were compared with results of radial head excision with synovectomy (RHES) in 45 age-matched patients treated in the same unit. The groups were similar with respect to duration of disease and preoperative clinical status, although pain was of longer duration and slightly more severe in the TER group. Failure was defined as the onset of moderate or severe pain after surgery or revision surgery for any reason. Reduction in pain was greater after TER than after RHES (P
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surgery for rheumatoid arthritis of the Elbow a comparison of radial head excision and synovectomy with total Elbow Replacement
Journal of Shoulder and Elbow Surgery, 1999Co-Authors: David A Woods, Nagui Gendi, Alastair G Mowat, Peter Burge, John R Williams, Andrew CarrAbstract:The results of total Elbow Replacement (TER) in 45 Elbows of 38 patients with rheumatoid arthritis were compared with results of radial head excision with synovectomy (RHES) in 45 age-matched patients treated in the same unit. The groups were similar with respect to duration of disease and preoperative clinical status, although pain was of longer duration and slightly more severe in the TER group. Failure was defined as the onset of moderate or severe pain after surgery or revision surgery for any reason. Reduction in pain was greater after TER than after RHES (P < .05). Recurrence of pain was common after RHES but was not seen after TER. Movement increased by a similar amount in each group. Complications were more frequent and more serious after TER (4 dislocations, 4 ulnar nerve dysfunctions, 1 significant wound breakdown) than after RHES (2 ulnar nerve dysfunctions, 1 transient wound discharge). Complications after TER were most common in patients who had previous RHES. On survival analysis, TER results were better than RHES results in each successive year. Cumulative survival rates at 10 years were 85% for TER and 69% for RHES, but the difference in rates was not statistically significant. In the medium term, TER relieves pain more reliably than RHES and its use is justified despite the greater risk of complications. In view of the paucity of long-term results for TER, RHES may retain a role in younger patients or in those whose symptoms are related mainly to the radiohumeral joint.
Allan E Inglis - One of the best experts on this subject based on the ideXlab platform.
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ipsilateral total shoulder arthroplasty and total Elbow Replacement arthroplasty
Journal of Arthroplasty, 2000Co-Authors: Allan E InglisAbstract:Abstract Shoulder and Elbow Replacement arthroplasty both achieve a high degree of success in patients with inflammatory arthritis. When both arthroplasties are performed on the same side, a stress riser can occur in the humeral diaphysis between the tips of the 2 humeral components. When the shoulder arthroplasty is performed first, a short-stemmed humeral component is advised. If a long-stemmed humeral component at either joint is already in place, the cement column for the subsequent arthroplasty should extend to and include the cement column for the extant component.
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case reportipsilateral total shoulder arthroplasty and total Elbow Replacement arthroplasty a caveat
Journal of Arthroplasty, 2000Co-Authors: Allan E InglisAbstract:Shoulder and Elbow Replacement arthroplasty both achieve a high degree of success in patients with inflammatory arthritis. When both arthroplasties are performed on the same side, a stress riser can occur in the humeral diaphysis between the tips of the 2 humeral components. When the shoulder arthroplasty is performed first, a short-stemmed humeral component is advised. If a long-stemmed humeral component at either joint is already in place, the cement column for the subsequent arthroplasty should extend to and include the cement column for the extant component.
Eero A. Belt - One of the best experts on this subject based on the ideXlab platform.
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long term survival of the souter strathclyde total Elbow Replacement in patients with rheumatoid arthritis
Journal of Bone and Joint Surgery-british Volume, 2010Co-Authors: Mikko Ikavalko, Raine Tiihonen, Eerik T Skytta, Eero A. BeltAbstract:Between 1982 and 1997, 403 consecutive patients (522 Elbows) with rheumatoid arthritis underwent Souter-Strathclyde total Elbow Replacement. By the end of 2007, there had been 66 revisions for aseptic loosening in 60 patients. The mean time of follow-up was 10.6 years (0 to 25) The survival rates at five-, ten, 15 and 19 years were 96% (95%, confidence interval (CI) 95 to 98), 89% (95% CI 86 to 92), 83% (95% CI 78 to 87), and 77% (95% CI 69 to 85), respectively. The small and medium-sized short-stemmed primary humeral components had a 5.6-fold and 3.6-fold risk of revision for aseptic loosening respectively, compared to the medium-sized long-stemmed component. The small and medium-sized all-polyethylene ulnar components had respectively a 28.2-fold and 8.4-fold risk of revision for aseptic loosening, compared to the metal-backed ulnar components. The use of retentive ulnar components was not associated with an increased risk of aseptic loosening compared to non-retentive implants.
C Dent - One of the best experts on this subject based on the ideXlab platform.
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OUTCOME OF TOTAL Elbow Replacement FOR DISTAL HUMERUS FRACTURES; A COMPARISON OF EARLY WITH DELAYED SURGERY
2011Co-Authors: N Prasad, C DentAbstract:We analysed the outcome of the Coonrad-Morrey total Elbow Replacement used for fracture of the distal humerus in elderly patients with no evidence of inflammatory arthritis and compared the results for early versus delayed treatment. We studied a total of 32 patients with 15 in the early treatment group and 17 in the delayed treatment group. The mean follow-up was 56.1 months (18 to 88). The percentage of excellent to good results based on the Mayo Elbow performance score was not significantly different, 84% in the early group and 79% in the delayed group. Subjective satisfaction was 92% in both the groups. One patient in the early group developed chronic regional pain syndrome and another type 4 aseptic loosening. Two Elbows in the early group also showed type 1 radiological loosening. Two patients in the delayed group had an infection, two an ulnar nerve palsy, one developed heterotopic ossification and one type 4 aseptic loosening. Two Elbows in this group also showed type 1 radiological loosening. The complication rates in the early and delayed treatment group were 13% and 29% respectively. The Kaplan-Meier survivorship analysis for the early and delayed treatment groups was 93% at 88 months and 76% at 84 months, respectively. No statistically significant difference was found between the two groups. We conclude that total Elbow Replacement provides a preditable and reproducible outcome in terms of pain relief and functional range of movement in elderly osteoporotic patients with difficult distal humerus fractures.
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outcome of total Elbow Replacement for rheumatoid arthritis single surgeon s series with souter strathclyde and coonrad morrey prosthesis
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Narayana Prasad, C DentAbstract:Background The reported outcome of total Elbow Replacement is inferior to hip and knee arthroplasty, and there might be an element of institutional bias. Methods We analyzed the outcome of Souter and Coonrad-Morrey total Elbow prosthesis in rheumatoid Elbow performed by a single surgeon from a center independent from standpoint of being involved in the designing or manufacturing of the implant. Results We had 44 Souter Elbows with a mean follow-up of 108 months and 55 Coonrad-Morrey Elbows with mean follow-up of 60 months. The Mayo Elbow Performance Score was comparable in both the groups with similar subjective satisfaction. Souter Elbow showed a survivorship of 92.9% at 5 years and 76% at 10 years, with aseptic loosening rate of 18% and instability of 9% as main reasons for the failure. The Coonrad-Morrey Elbow shows 100% survival at mean follow-up of 5 years in our series. Conclusion We find high rate of instability and loosening of Souter prosthesis with an inferior 5-year survival compared to Coonrad-Morrey prosthesis.
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total Elbow Replacement for distal humeral fractures
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: Harshad V. Dabke, S Sarasin, M. Pritchard, R. Kulkarni, C DentAbstract:Aim: To study the role of total Elbow Replacement in the management of distal humeral fractures in elderly patients.Patients and methods: Between 1995 and 2003, 25 consecutive patients with fractures of the distal humerus were treated by primary total Elbow Replacement using the Coonrad-Morrey prosthesis. All surgeries were performed by one of the senior authors in two centers in South Wales. There were 18 females and 7 males and none of them had inflammatory or degenerative arthritis of the Elbow. The mean age at the time of injury was 78 years (68–84). According to the AO classification, 16 patients had suffered a C3 injury, five type B3 and three type A3. One fracture was unclassified. The mean time to follow-up was 4 years (1–9 years).Results: At follow-up 19 patients (76%) reported no pain, five (20%) had mild pain with activity and one had mild pain at rest. The mean flexion arc was 28 degrees to 105 degrees. The mean supination was 69 degrees (50–90) and pronation 70 degrees (50–80). No Elbow was u...
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TOTAL Elbow Replacement FOR DISTAL HUMERAL FRACTURES
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: Harshad V. Dabke, S Sarasin, M. Pritchard, R. Kulkarni, C DentAbstract:Aim: To study the role of total Elbow Replacement in the management of distal humeral fractures in elderly patients. Patients and methods: Between 1995 and 2003, 25 consecutive patients with fractures of the distal humerus were treated by primary total Elbow Replacement using the Coonrad-Morrey prosthesis. All surgeries were performed by one of the senior authors in two centers in South Wales. There were 18 females and 7 males and none of them had inflammatory or degenerative arthritis of the Elbow. The mean age at the time of injury was 78 years (68–84). According to the AO classification, 16 patients had suffered a C3 injury, five type B3 and three type A3. One fracture was unclassified. The mean time to follow-up was 4 years (1–9 years). Results: At follow-up 19 patients (76%) reported no pain, five (20%) had mild pain with activity and one had mild pain at rest. The mean flexion arc was 28 degrees to 105 degrees. The mean supination was 69 degrees (50–90) and pronation 70 degrees (50–80). No Elbow was unstable. Mean Mayo Elbow performance score was 71.5(25–100). Four patients (16%) developed ulnar neuropraxia following surgery that improved with time, 2 patients developed superficial wound infection (staphylococcus aureus), which was treated with antibiotics only. None of the above Elbows required revision to date. Radiological evaluation revealed only one patient with a radio-lucent line at the cement -bone interface. It was between 1 and 2mm in length, was present on the initial postoperative radiograph and was non-progressive at the time of follow-up. Conclusion: Primary total Elbow arthroplasty is an acceptable option for the management of comminuted fractures of the distal humerus in elderly patients when the configuration of the fracture and the quality of the bone make reconstruction difficult.