Total Elbow Arthroplasty in the Treatment of Posttraumatic Conditions of the Elbow

Posttraumatic arthritis, arthritis secondary to instability, and nonunion or malunion about the elbow may be treated by various methods. Recommended first-line treatment in the younger, more active patient population is nonprosthetic techniques. Total elbow arthroplasty should be considered primarily as a salvage procedure for these patients. Careful patient selection will determine whether total elbow arthroplasty is an acceptable choice, despite its inherent risks and complications. Prosthetic replacement is more applicable for patients with low physical demands who are older than 60 years of age with pain, stiffness, and/or instability of the elbow who will more likely be able to comply with postoperative rehabilitation and strict activity restrictions. Previous incisions, gross instability, periarticular fibrosis with ulnar nerve encasement, loss of bone and/or soft tissue, and previous infections represent obstacles for prosthetic reconstruction in these patients. The use of unlinked total elbow designs require good bone stock with little deformity and stable capsuloligamentous support, which uncommonly is found in elbows after trauma. Linked semiconstrained prostheses have been used most frequently with good short-term results reported in the literature. Reported failure rates after longer followup have led to a search for improvements in prosthetic design, cementing techniques, and better patient selection.