Cutis Autograft Interposition Arthroplasty of the Elbow: Twenty-Three Year Survivorship and Successful Conversion to Total Elbow Arthroplasty

Published on May 1, 2021in Seminars in Arthroplasty
· DOI :10.1053/J.SART.2020.10.001
Maheen Nadeem1
Estimated H-index: 1
(Case Western Reserve University),
Tristan de Mooij1
Estimated H-index: 1
(EUR: Erasmus University Rotterdam)
+ 1 AuthorsWilliam H. Seitz21
Estimated H-index: 21
(Cleveland Clinic)
Sources
Abstract
Elbow arthritis can lead to significant upper limb dysfunction in everyday activities due to the elbow's key role in positioning the dominant hand. Osteoarthritis may develop in the elbow after overuse injury, trauma, osteochondritis dissecans, osteochondromatosis, crystal-induced arthropathies, and sequelae of septic arthritis or hemophilia [3] . Treatment options for primary or secondary elbow arthritis that disrupts function include arthroscopic debridement, arthrodesis, resection arthroplasty, interposition arthroplasty (IA) and total elbow arthroplasty (TEA) [6] . The use of membranous interposition or distraction in arthritic joints dates back to 1860 [29] . While fascia lata [ 5 , 13 ], cutis graft [10] , Achilles tendon allograft and AlloDerm (LifeCell, Branchburg, New Jersey, USA) are preferred materials, bovine collagen [16] , Gelfoam (Pharmacia and Upjohn, Kalamazoo, Michigan, USA), Ivalon sponge [7] , and silicone [28] have been used with success rates ranging from 26 to 94% [ 17 , 19 , 20 , 22 , 23 ]. The original concept has been further modified by hinged distraction external fixation, which allows for early motion while protecting the graft and healing ligaments from stretching or failing early on [ 5 , 9 , 30 ]. Soft tissue reconstruction of medial and lateral collateral ligaments as well as bone grafting make IA possible even in cases complicated by instability or bone loss [12] . Current IA surgical techniques have been described by Chen et al [4] . Active infection, open physes, and absence of flexor motor power are the main contra-indications [ 10 , 19 ]. Gross instability and/or deformity at rest are relative contraindications considering their association with poorer outcomes [18] . Historically, the classic indication for TEA is an inflammatory arthropathy that has invariably destroyed the elbow joint because outcomes have shown significant improvements in pain and function in these patients [11] . If joints are caught early enough in the course of Rheumatoid Arthritis, ligament integrity and bone stock are usually sufficient to allow for implant arthroplasty [25] . Additionally, as patients with a systemic joint disease, they are unlikely to be so physically active that mechanical failure would occur. Posttraumatic osteoarthritis of the elbow presents difficulties in management particularly because these patients are younger and more active. As younger patients are not considered prime candidates for TEA, this leaves many younger adults with posttraumatic elbow arthritis finding IA to be their best option. While TEA yields better average pain relief than IA, it imposes a weight lifting restriction beyond 5 kilograms and can therefore be unrealistic for young, active patients [24] . Furthermore, Schneeberger et al [27] reported a 27% complication rate in young patients undergoing TEA and Celli et al [2] reported a 37% revision rate within 7 years in young TEA-recipients, making TEA an unfavorable option. Complications are often severe and thus necessitate return to the operating room [11] . While IA is technically challenging and rarely performed, it preserves functional range of motion, does not impose weight restrictions and, while only a few reports of revision exist, can be converted successfully to TEA as is shown in this presented case [ 1 , 4 ].
References29
Newest
#1Maritz Laubscher (UCT: University of Cape Town)H-Index: 9
#2A Vochteloo (UCT: University of Cape Town)H-Index: 2
Last. Stephen Roche (UCT: University of Cape Town)H-Index: 10
view all 5 authors...
BackgroundInterposition arthroplasty (IA) is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. The outcome and complications of an IA were evaluated.MethodsWe retrospectively reviewed 18 consecutive cases of interposition arthroplasty (IA) (one case was excluded as a result of incomplete records). Pre- and postoperative pain and function were evaluated. Complications, re-operations and revisions were recorded.ResultsThe mean...
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Abstract Post-traumatic osteoarthritis of the elbow is an uncommon condition in which the clinical manifestations are often at variance with the radiological findings. In symptomatic forms, pain and stiffness are variably combined. When non-operative management fails, the decision to perform surgery is taken on a case-by-case basis depending on age, activity level, patient discomfort, and osteoarthritis location and severity as assessed by CT scan arthrography. Elbow instability or subluxation s...
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#1Darwin Chen (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 10
#2David A. Forsh (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 4
Last. Michael R. Hausman (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 21
view all 3 authors...
: End-stage elbow arthritis in young, active patients presents a challenging problem to the upper extremity surgeon. Total elbow arthroplasty is not a viable option in this population because of functional restrictions, limited implant survivorship, and the lack of an adequate salvage option. With the appropriate surgical indication, interposition arthroplasty can relieve severe pain, affording a functional elbow without severely proscribing permitted activities. In addition, bone stock is prese...
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Total elbow arthroplasty has continued to evolve over time. Elbow implants may be linked or unlinked. Unlinked implants are attractive for patients with relatively well preserved bone stock and ligaments, but many favor linked implants, since they prevent instability and allow replacement for a wider spectrum of indications. Inflammatory arthropathies such as rheumatoid arthritis represent the classic indication for elbow arthroplasty. Indications have been expanded to include posttraumatic oste...
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Background: It is generally accepted that prosthetic elbow replacement should be avoided in young patients because of an anticipated high rate of early failure. The purpose of this paper was to define the success, prosthetic survival rate, and problems encountered in patients who were treated with a semiconstrained total elbow arthroplasty when they were forty years of age or less. Methods: We retrospectively reviewed the records of 758 patients who had undergone primary arthroplasty with the Co...
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Complex instability of the elbow, also known as fracture dislocation of the elbow, is one of the most challenging injuries of the musculoskeletal system. A clear understanding of the biomechanics of the joint with special focus on the relative contributions of the articular components and the ligamentous constraints is critical to the proper management of these injuries. The accurate recognition and implications of associated injuries offers a rationale for approaching these difficult problems b...
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Background: Interposition arthroplasty is often considered to be a salvage option for the treatment of severe elbow arthritis when conservative treatment has failed and total joint replacement is contraindicated. The present retrospective study summarizes the results of a specific interposition arthroplasty technique for the treatment of inflammatory and posttraumatic arthritis of the elbow. Methods: Between 1996 and 2003, sixty-nine elbows were treated with interposition arthroplasty with an Ac...
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#1Jose Nolla (Harvard University)H-Index: 1
#2David Ring (Harvard University)H-Index: 103
Last. Jesse B. Jupiter (Harvard University)H-Index: 103
view all 4 authors...
This retrospective case series reviewed 9 men and 4 women (mean age, 41 years) with severe post-traumatic elbow arthrosis treated with interposition arthroplasty and temporary hinged external fixation. In 2 patients, treatment was considered to have failed because of early postoperative instability, and their results were classified as poor. The remaining 11 were followed up for a mean of 4 years (range, 1-11 years). The mean arc of flexion improved from 48° before surgery to 110° after surgery....
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A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years’ follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgic...
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Cited By1
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Abstract Introduction Constrain of a total elbow replacement and elbow arthrodesis are too much for the working population to bear. As such interpositional elbow arthroplasty using fascia lata autologous graft to reconstruct the elbow joint is a viable option in this age group. Materials and method 8 patients were operated for arthritic stiff elbow, and joint reconstruction was done using fascia lata autologous graft, with out the use of any hinged external fixator. Pre-operative and post-operat...
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