ELBOW JOINT REPLACEMENT CURRENT STATUS
ELBOW JOINT REPLACEMENT Options Uncoupled - Resurfacing - Unconstrained Coupled - Constrained - Semiconstrained
ELBOW JOINT REPLACEMENT Resurfacing Implants UTILIZATION PATTERNS Capitellocondylar - U.S. Kudo - Japan, U.K. Souter Strathclyde - U.K. Eurorope Sorbie - Canada, U.S. Latitude – Canada, U.S.
ELBOW JOINT REPLACEMENT Kudo - R.A. Procedures 15 Surveillance/yr 3 Pain relief 100% > Motion 30 deg. Complication 17% Unstable 12% Satisfied 87%
ELBOW JOINT REPLACEMENT Capitellocondylar - R.A. Procedures 202 Surveillance/yr 6yrs. (2-15) Pain relief 92% > Motion 30 deg. Complication 30% Reoperation 8%
ELBOW JOINT REPLACEMENT Souter - R.A. Procedures 19 Surveillance/yr 3-5yrs. Pain relief 100% > Motion 30 deg. Complication 30% Loose 11% Dislocations 16%
ELBOW JOINT REPLACEMENT * Technically demanding * Limited indications * Instability/ROM issues Resurfacing Implants
ELBOW JOINT REPLACEMENT Semiconstrained TEA Experience Mayo Experience
ELBOW JOINT REPLACEMENT REPLICATES NORMAL KINEMATICS
ELBOW JOINT REPLACEMENT RESISTS POSTERIOR DISPLACEMENT & TORSIONAL STRESS at INTERFACE
ELBOW JOINT REPLACEMENT - 1978 semiconstrained - 1981 Anterior flange 20 YEAR EXPERIENCE Essential Elements
COONRAD-MORREY TEA 1978 – Present Modifications 1976 - Original Design 1981 - Plasma Spray/Flange 1985 - Beads 1991- Precoat 1998 - Pin within Pin 2000 - Beaded Humeral - Plasma Spray Ulna - Interchangeable
SEMICONSTRAINED TEA PROCEDURES - 927 (1982 - ) RA 330 (35%) MAYO EXPERIENCE PROCEDURES - 927 (1982 - ) RA 330 (35%) PT 269 (29%) Revision 232 (25%)
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS Staging - Mayo I - Synovitis,articulation intact II - Synovitis, joint narrowing III - Architectural change: (A) Moderate (B) Severe IV - Gross destruction (mutilans)
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS 10 -15 Yr. FU Preoperative Radiographic Assessment Class (%) Type 4 27 Type 3 71 Type 2 3 Type 1 --
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS 10 -15 Yr. FU Pain Relief 97% Motion 28 - 131
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS 10 -15 Yr. FU SATISFACTORY RESULT * Objective - MEPS 86% * Subjective 92%
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS 10 -15 Yr. FU Survival 93% Satisfaction 86 %
SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS 10 -15 Yr. FU CONCLUSIONS Reliable implant Functional restoration Spectrum of Involvement Comp/reop. Reasonable range
ELBOW JOINT REPLACEMENT Arthritis TRAUMATIC CONDITIONS - Acute Fractures - Traumatic Arthritis - Instability - Stiffness
ELBOW JOINT REPLACEMENT Acute Fracture Indications for replacement - Articular involvement - Severe comminution - Age > 65 years
TEA FOR ACUTE FRACTURE Technique - Triceps sparing - Non -custom implant - Immediate motion - No Physical Therapy
TEA FOR ACUTE FRACTURE German Experience Patients 77 Results Excellent/Good 52% Fair/Poor 48%
MAXIMUM OSSEOUS DEFICIENCY 8CM Absence of Humerus
TEA FOR ACUTE FRACTURE Results Procedures 22 (1982-1992) Surveillance 5 years
TEA FOR ACUTE FRACTURE Postoperative Management Hospital (LOS) 5 days (2-7) Physical Therapy 0
TEA FOR ACUTE FRACTURE Results Motion E/F: 24 -132 Function 42/50 (MEPS) Results SATISFACTION - 93%
TEA FOR TRAUMATIC ARTHRITIS Results Procedures 41 (1982-1993) Surveillance 6.5 years
TEA FOR TRAUMATIC ARTHRITIS Complications No. (%) Fx Ulnar Component 5 12 Worn Bushing 2 5 Infections 2 5 Fx. Ulna, Rad.Head Ulnar n., triceps 13 31
TEA FOR TRAUMATIC ARTHRITIS Results -Patients 41 -Surveillance 6 yrs. (2-12) -Satisfactory Objective 83% Subjective 95%
TEA FOR TRAUMATIC ARTHRITIS Results Motion ARC P/S Pre-op 40-118 61/67 Post-op 27-131 66/86 SATISFACTION: 83% Objective 94% Subjective
TEA FOR DISTAL HUMERAL NONUNION Results Procedures 39(1982-1991) Surveillance 4.5 years
TEA FOR DISTAL HUMERAL NONUNION MONOTONOUS PATTERN
TEA FOR DISTAL HUMERAL NONUNION Results Satisfactory Subjective 91% Objective 88%
TEA FOR DISTAL HUMERAL NONUNION Results Summary Procedures 39 Surveillance 4.5 yrs. Satisfactory 91% Complications 18%
TEA FOR TRAUMATIC ARTHRITIS JBJS No. F/U Satis.% Acute 79A,1997 21 5yr. 92 Arthritis 79A,1997 41 5yr. 92 Nonunion 77B,1995 39 4.5yr. 91
Semiconstrained TEA for Trauma RELIABLE OPTION CONCLUSIONS BROAD SPECTRUM of PATHOLOGY FUNCTIONAL RESTORATION HIGH COMPLICATION RATE REQUIRES EXPERIENCE
TEA SURGICAL TECHNIQUE Approach
TEA SURGICAL TECHNIQUE Ulnar Nerve
TEA SURGICAL TECHNIQUE Ulnar Nerve
TEA SURGICAL TECHNIQUE Sharpey’s Fibers
TEA SURGICAL TECHNIQUE Sharpey’s Fibers
TEA SURGICAL TECHNIQUE Olecranon Reflection
TEA SURGICAL TECHNIQUE MCL Release
TEA SURGICAL TECHNIQUE Olecranon Tip
TEA SURGICAL TECHNIQUE Manuever
TEA SURGICAL TECHNIQUE Manuever
TEA SURGICAL TECHNIQUE Rongeur
TEA SURGICAL TECHNIQUE Rongeur
TEA SURGICAL TECHNIQUE Burr
TEA SURGICAL TECHNIQUE Twist Reamer
TEA SURGICAL TECHNIQUE Twist Reamer
TEA SURGICAL TECHNIQUE Twist Reamer
TEA SURGICAL TECHNIQUE Cutting Guide
TEA SURGICAL TECHNIQUE Cutting Guide
TEA SURGICAL TECHNIQUE Oscillating Saw
TEA SURGICAL TECHNIQUE Oscillating Saw
TEA SURGICAL TECHNIQUE Cross Hatching
TEA SURGICAL TECHNIQUE Cross Hatching
TEA SURGICAL TECHNIQUE Humeral Rasp
TEA SURGICAL TECHNIQUE Humeral Rasp
TEA SURGICAL TECHNIQUE Humeral Trial Reduction
TEA SURGICAL TECHNIQUE Ulnar Burr
TEA SURGICAL TECHNIQUE Ulnar Burr
TEA SURGICAL TECHNIQUE Ulnar pilot
TEA SURGICAL TECHNIQUE Ulnar Starter
TEA SURGICAL TECHNIQUE Ulnar Rasp
TEA SURGICAL TECHNIQUE Ulnar Position
TEA SURGICAL TECHNIQUE Ulnar Position
TEA SURGICAL TECHNIQUE Ulnar Trial Reduction
TEA SURGICAL TECHNIQUE Ulnar Cement
TEA SURGICAL TECHNIQUE Humeral Cement
TEA SURGICAL TECHNIQUE Plate Bending
TEA SURGICAL TECHNIQUE Bone graft
TEA SURGICAL TECHNIQUE Graft Flange
TEA SURGICAL TECHNIQUE Pin Assembly
TEA SURGICAL TECHNIQUE Implant Seating
TEA SURGICAL TECHNIQUE Triceps Attachment
TEA SURGICAL TECHNIQUE Triceps Cruciate
TEA SURGICAL TECHNIQUE Triceps Attachment
TEA SURGICAL TECHNIQUE Ulnar Nerve Transposition
TEA SURGICAL TECHNIQUE Ulnar Nerve Transposition
TEA SURGICAL TECHNIQUE Closure
TEA SURGICAL TECHNIQUE Post op Protocol Ice & Elevation for 24 - 36 hours (Cryocuff) PROM begins at 36 hours Discharge when hand to mouth (3-4 days) Activities of Daily Living (No heavy Lifting) No more than 2lbs repetitively No more than 5lbs a single event