Total Elbow Arthroplasty
Description
Total Elbow Arthroplasty (TEA) is the surgical excision and replacement of the ulno-humeral articulation with a suitable prosthesis. This procedure is sometimes done with or without replacing the radio-capitular and radio-ulnar joints.[1]
Because the radiocapitular joint contributes significantly to elbow stability and load transmission, particularly in the lateral column of the elbow( important in preventing valgus and axial instability), excision of the radial head may result in instability of the lateral elbow column, consequently increasing stress on the ulnohumeral joint. However, it is more challenging in post traumatic arthritis. [2] [3]
Indication
(TEA) was originally done with patients suffering from rheumatoid arthritis (R.A.) in mind. To this day, most TEA procedures are done on end-stage RA patients. [4]Other indications include:[5]
- End-stage rheumatoid arthritis
- Older patients (>65 years old) with low functional demands.
- Severe primary osteoarthritis.
- Irreparable distal humeral fracture
- Distal humeral non-union fracture
- Post-traumatic osteoarthritis
- Post-bone tumor resection[6]
Research found that better results are obtained for patients with inflammatory arthritis (e.g., RA) than those done on patients with post-traumatic conditions.[7]
Clinically Relevant Anatomy
The elbow joint, a complex synovial articulation, comprises three distinct interconnected articulations within a shared synovial space: the ulnohumeral, radiohumeral, and proximal radioulnar joints. These articulations collectively facilitate both sagittal plane motion (flexion-extension at the elbow) and axial rotation of the forearm (pronation-supination).[8]
Diagnostic Procedures
An assessment by an orthopaedic surgeon consists of several components:
- Full medical history and how elbow symptoms affect the ability to perform ADLs.
- Elbow joint examination
- X-rays. Assess the extent of damage or deformity in the elbow.
Owing to the relatively lower prevalence of total elbow arthroplasty (TEA) compared to hip and knee arthroplasty, most surgeons have limited experience with this procedure. As a result, there is a scarcity of long-term outcome data within the current literature.[9]But the diagnosis of patients requiring TEA is mostly based on severe rheumatoid arthritis of the elbow joint and posttraumatic degenerative elbow joint disease.[10]
Post Total Elbow Arthroplasty Physiotherapy
The main aim of rehabilitation process following TEA is to maximize functional recovery, particularly with respect to elbow joint mobility, frequently quantified as range of motion (ROM), and the ability to execute activities of daily living
An early beginning of physiotherapy has been shown to positively influence functional outcomes, healthcare costs, hospital length of stay, and the incidence of adverse events during inpatient care. However, the majority of available research pertains to hip and knee joint replacements, and comparative analyses of diverse rehabilitation protocols or regimens for other joint sites are limited by a paucity of studies and the heterogeneity of implemented interventions. [11]
References
- ↑ Bachman D, Cil A. Current concepts in elbow arthroplasty. EFORT Open Reviews. 2017 Apr 1;2(4):83-8. [1]
- ↑ Momtaz D, Ahmad F, Cushing T, Gonuguntla R, Ghali A, Jabin M, Miggins J, Khalafallah Y, Mitchell S. Radiocapitellar arthroplasty: systematic review. Journal of Shoulder and Elbow Arthroplasty. 2023 Jan;7:24715492231152735. [2]
- ↑ Antoni M, Ginot G, Mereb T, Clement X, Eichler D, Kempf JF, Clavert P. Post-traumatic elbow osteoarthritis after radial head arthroplasty: prevalence and risk factors. Orthopaedics & Traumatology: Surgery & Research. 2021 Apr 1;107(2):102814.
- ↑ Mahamid A, Jayyusi F, Laver L, Haj Yahya M, Wolff G, Yassin A, Behrbalk E. Analyzing Declining Trends, Patient Demographics, and Complications in Total Elbow Arthroplasty: Nationwide Retrospective Data Analysis. Journal of Clinical Medicine. 2025 Feb 28;14(5):1645.
- ↑ Triplet JJ, Kurowicki J, Momoh E, et al. Trends in total elbow arthroplasty in the Medicare population: a nationwide study of records from 2005 to 2012. J Shoulder Elbow Surg 2016;25:1848-1853.
- ↑ Sperling JW, Pritchard DJ, Morrey BF. Total elbow arthroplasty after resection of tumors at the elbow. Clin Orthop Relat Res 1999;367:256-261.
- ↑ Wang JH, Ma HH, Chou TF, Tsai SW, Chen CF, Wu PK, Chen WM. Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis. The Bone & Joint Journal. 2019 Dec 1;101(12):1489-97.[3]
- ↑ Aquilina AL, Grazette AJ. Clinical anatomy and assessment of the elbow. The Open Orthopaedics Journal. 2017 Nov 30;11:1347. [4]
- ↑ Kwak JM, Koh KH, Jeon IH. Total elbow arthroplasty: clinical outcomes, complications, and revision surgery. Clinics in orthopedic surgery. 2019 Dec 1;11(4):369-79.[5]
- ↑ Brumfield Jr RH, Kuschner SH, Gellman H, Redix L, Stevenson DV. Total elbow arthroplasty. The Journal of Arthroplasty. 1990 Dec 1;5(4):359-63. [6]
- ↑ Hesseberg K, Storronning I, Sand SM, Smedslund G. Rehabilitation after total or hemi elbow arthroplasty: a systematic review. Orthopedic Reviews. 2024 Apr 3;16:115597. [7]