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Interposition Arthroplasty with an Achilles Tendon Allograft as a Salvage Procedure for the Elbow
A. Noelle Larson, MD1; Bernard F. Morrey, MD1
1 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Dec 01;90(12):2714-2723. doi: 10.2106/JBJS.G.00768
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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 Achilles tendon allograft. Forty-five elbows, including eleven with inflammatory arthritis and thirty-four with posttraumatic arthritis, met our inclusion criteria. The mean patient age was thirty-nine years. The mean duration of clinical follow-up was 6.0 years. Seven patients subsequently underwent revision surgery and were excluded from the analysis. For the thirty-eight remaining patients with surviving allografts, the current Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score were obtained and the most recent clinical outcomes and radiographs were reviewed.

Results: In the group of thirty-eight patients with surviving allografts, the mean flexion-extension arc improved from 51° preoperatively to 97° postoperatively (p < 0.001). The mean Mayo Elbow Performance Score improved from 41 points preoperatively to 65 points postoperatively (p < 0.0001). Thirteen patients had a good or excellent result, fourteen had a fair result, and eleven had a poor result; the remaining seven had a revision. On the basis of the Mayo Elbow Performance Score, twelve patients rated the elbow as somewhat better and nineteen rated the elbow as much better following the interposition procedure. Despite efforts to reconstruct the collateral ligaments, preoperative instability on physical examination (found in eleven patients) was associated with low Mayo Elbow Performance Scores (p = 0.03) and high Disabilities of the Arm, Shoulder and Hand scores (p = 0.006). Four of five patients undergoing reconstruction of both collateral ligaments had a net decrease in the Mayo Elbow Performance Score.

Conclusions: We consider interposition elbow arthroplasty to be a salvage procedure as it neither completely eliminates pain nor restores full function. It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis, especially those with limited elbow motion. Furthermore, we do not recommend this procedure when patients present with preoperative instability on physical examination.

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

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    Accreditation Statement
    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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