1. ELBOW JOINT REPLACEMENT
CURRENT STATUS

2. ELBOW JOINT REPLACEMENT
Options
Uncoupled
- Resurfacing
- Unconstrained
Coupled
- Constrained
- Semiconstrained

3. 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.

4. ELBOW JOINT REPLACEMENT
Kudo - R.A.
Procedures
Surveillance/yr 3
Pain relief %
> Motion deg.
Complication 17%
Unstable %
Satisfied %

5. ELBOW JOINT REPLACEMENT
Capitellocondylar - R.A.
Procedures
Surveillance/yr 6yrs. (2-15)
Pain relief %
> Motion deg.
Complication 30%
Reoperation %

6. ELBOW JOINT REPLACEMENT
Souter - R.A.
Procedures
Surveillance/yr 3-5yrs.
Pain relief %
> Motion deg.
Complication 30%
Loose %
Dislocations %

7. ELBOW JOINT REPLACEMENT
* Technically demanding
* Limited indications
* Instability/ROM issues
Resurfacing Implants

8. ELBOW JOINT REPLACEMENT
Semiconstrained TEA Experience
Mayo Experience

9. ELBOW JOINT REPLACEMENT
REPLICATES NORMAL KINEMATICS

10. ELBOW JOINT REPLACEMENT
RESISTS POSTERIOR DISPLACEMENT & TORSIONAL
STRESS at INTERFACE

11. ELBOW JOINT REPLACEMENT
semiconstrained
Anterior flange
20 YEAR EXPERIENCE
Essential Elements

12. COONRAD-MORREY TEA 1978 – Present
Modifications
Original Design
Plasma Spray/Flange
Beads
1991- Precoat
Pin within Pin
Beaded Humeral
- Plasma Spray Ulna
- Interchangeable

13. SEMICONSTRAINED TEA PROCEDURES - 927 (1982 - ) RA 330 (35%)
MAYO EXPERIENCE
PROCEDURES ( )
RA (35%)
PT (29%)
Revision (25%)

14. 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)

15. SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS
Yr. FU
Preoperative Radiographic Assessment
Class (%)
Type
Type
Type
Type

16. SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS
Yr. FU
Pain Relief %
Motion

17. SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS
Yr. FU
SATISFACTORY RESULT
* Objective - MEPS 86%
* Subjective %

20. SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS
Yr. FU
Survival %
Satisfaction %

22. SURGICAL MANAGEMENT OF RHEUMATOID ARTHRITIS
Yr. FU
CONCLUSIONS
Reliable implant
Functional restoration
Spectrum of Involvement
Comp/reop. Reasonable range

23. ELBOW JOINT REPLACEMENT
Arthritis
TRAUMATIC CONDITIONS
- Acute Fractures
- Traumatic Arthritis
- Instability
- Stiffness

24. ELBOW JOINT REPLACEMENT
Acute Fracture
Indications for replacement
- Articular involvement
- Severe comminution
- Age > 65 years

26. TEA FOR ACUTE FRACTURE Technique - Triceps sparing
- Non -custom implant
- Immediate motion
- No Physical Therapy

27. TEA FOR ACUTE FRACTURE German Experience Patients 77 Results
Excellent/Good %
Fair/Poor %

28. MAXIMUM OSSEOUS DEFICIENCY
8CM Absence of Humerus

29. TEA FOR ACUTE FRACTURE Results Procedures 22 (1982-1992)
Surveillance years

30. TEA FOR ACUTE FRACTURE Postoperative Management
Hospital (LOS) 5 days (2-7)
Physical Therapy

31. TEA FOR ACUTE FRACTURE Results Motion E/F: 24 -132
Function 42/50 (MEPS)
Results
SATISFACTION - 93%

32. TEA FOR TRAUMATIC ARTHRITIS
Results
Procedures ( )
Surveillance years

35. TEA FOR TRAUMATIC ARTHRITIS
Complications
No (%) Fx Ulnar Component
Worn Bushing
Infections
Fx. Ulna, Rad.Head
Ulnar n., triceps

36. TEA FOR TRAUMATIC ARTHRITIS
Results
-Patients 41
-Surveillance 6 yrs. (2-12)
-Satisfactory
Objective %
Subjective 95%

37. TEA FOR TRAUMATIC ARTHRITIS
Results
Motion ARC P/S
Pre-op /67
Post-op /86
SATISFACTION:
83% Objective
94% Subjective

38. TEA FOR DISTAL HUMERAL NONUNION
Results
Procedures 39( )
Surveillance 4.5 years

40. TEA FOR DISTAL HUMERAL NONUNION
MONOTONOUS PATTERN

41. TEA FOR DISTAL HUMERAL NONUNION
Results
Satisfactory
Subjective 91%
Objective 88%

42. TEA FOR DISTAL HUMERAL NONUNION
Results
Summary
Procedures 39
Surveillance 4.5 yrs.
Satisfactory 91%
Complications 18%

43. TEA FOR TRAUMATIC ARTHRITIS
JBJS No. F/U Satis.%
Acute A, yr
Arthritis 79A, yr
Nonunion 77B, yr

44. Semiconstrained TEA for Trauma
RELIABLE OPTION
CONCLUSIONS
BROAD SPECTRUM of PATHOLOGY
FUNCTIONAL RESTORATION
HIGH COMPLICATION RATE
REQUIRES EXPERIENCE

45. TEA SURGICAL TECHNIQUE
Approach

46. TEA SURGICAL TECHNIQUE
Ulnar Nerve

47. TEA SURGICAL TECHNIQUE
Ulnar Nerve

48. TEA SURGICAL TECHNIQUE
Sharpey’s Fibers

49. TEA SURGICAL TECHNIQUE
Sharpey’s Fibers

50. TEA SURGICAL TECHNIQUE
Olecranon Reflection

51. TEA SURGICAL TECHNIQUE
MCL Release

52. TEA SURGICAL TECHNIQUE
Olecranon Tip

53. TEA SURGICAL TECHNIQUE
Manuever

54. TEA SURGICAL TECHNIQUE
Manuever

55. TEA SURGICAL TECHNIQUE
Rongeur

56. TEA SURGICAL TECHNIQUE
Rongeur

57. TEA SURGICAL TECHNIQUE
Burr

58. TEA SURGICAL TECHNIQUE
Twist Reamer

59. TEA SURGICAL TECHNIQUE
Twist Reamer

60. TEA SURGICAL TECHNIQUE
Twist Reamer

61. TEA SURGICAL TECHNIQUE
Cutting Guide

62. TEA SURGICAL TECHNIQUE
Cutting Guide

63. TEA SURGICAL TECHNIQUE
Oscillating Saw

64. TEA SURGICAL TECHNIQUE
Oscillating Saw

65. TEA SURGICAL TECHNIQUE
Cross Hatching

66. TEA SURGICAL TECHNIQUE
Cross Hatching

67. TEA SURGICAL TECHNIQUE
Humeral Rasp

68. TEA SURGICAL TECHNIQUE
Humeral Rasp

69. TEA SURGICAL TECHNIQUE
Humeral Trial Reduction

70. TEA SURGICAL TECHNIQUE
Ulnar Burr

71. TEA SURGICAL TECHNIQUE
Ulnar Burr

72. TEA SURGICAL TECHNIQUE
Ulnar pilot

73. TEA SURGICAL TECHNIQUE
Ulnar Starter

74. TEA SURGICAL TECHNIQUE
Ulnar Rasp

75. TEA SURGICAL TECHNIQUE
Ulnar Position

76. TEA SURGICAL TECHNIQUE
Ulnar Position

77. TEA SURGICAL TECHNIQUE
Ulnar Trial Reduction

78. TEA SURGICAL TECHNIQUE
Ulnar Cement

79. TEA SURGICAL TECHNIQUE
Humeral Cement

80. TEA SURGICAL TECHNIQUE
Plate Bending

81. TEA SURGICAL TECHNIQUE
Bone graft

82. TEA SURGICAL TECHNIQUE
Graft Flange

83. TEA SURGICAL TECHNIQUE
Pin Assembly

84. TEA SURGICAL TECHNIQUE
Implant Seating

85. TEA SURGICAL TECHNIQUE
Triceps Attachment

86. TEA SURGICAL TECHNIQUE
Triceps Cruciate

87. TEA SURGICAL TECHNIQUE
Triceps Attachment

88. TEA SURGICAL TECHNIQUE
Ulnar Nerve Transposition

89. TEA SURGICAL TECHNIQUE
Ulnar Nerve Transposition

90. TEA SURGICAL TECHNIQUE
Closure

91. TEA SURGICAL TECHNIQUE
Post op Protocol
Ice & Elevation for 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