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Total Elbow Arthroplasty After Interposition Arthroplasty for Elbow Arthritis
Theodore A. Blaine, MD1; Robert Adams, PA2; Bernard F. Morrey, MD2
1 Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH-1120, New York, NY 10032
2 Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. B.F. Morrey received royalties with the Coonrad-Morrey total elbow arthroplasty. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Feb 01;87(2):286-292. doi: 10.2106/JBJS.03031pp
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Background: Interposition arthroplasty is an option for the treatment of arthritis of the elbow. Conversion to a total elbow arthroplasty can be considered later, when the patient reaches a suitable age. We investigated the results of conversion of an interpositional elbow arthroplasty to a semiconstrained total elbow arthroplasty in a series of patients.

Methods: The results of twelve consecutive linked semiconstrained total elbow arthroplasties in twelve patients who had had a prior interposition arthroplasty for the treatment of degenerative arthritis of the elbow were evaluated at an average of ten years postoperatively. The average age at the time of the total elbow arthroplasty was fifty years, and the average interval from the interposition arthroplasty to the total elbow arthroplasty was 9.9 years. Pain and elbow performance as measured with the Mayo Elbow Performance Score were assessed in a retrospective chart review and an evaluation of questionnaires, and postoperative radiographs were reviewed.

Results: At the time of the latest follow-up, postoperative pain was rated as mild or none in ten of the twelve patients, and the result was rated as subjectively satisfactory in ten patients. The average Mayo Elbow Performance Score improved from 32.1 points (range, 10 to 70 points) preoperatively to 80.4 points (range, 40 to 100 points) postoperatively (p < 0.001). According to these objective criteria, there were three excellent, six good, one fair, and two poor results. All of the elbows were stable following the arthroplasty. Radiographs demonstrated a well-fixed prosthesis in all but one patient who had extensive osteolysis at the site of the humeral component. One other patient had radiographic evidence of bushing wear. Both of these patients required revision procedures.

Conclusions: Semiconstrained total elbow arthroplasty can be performed successfully in patients with a prior interposition arthroplasty. Reliable pain relief and a satisfactory result can be achieved in most patients.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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