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Scientific Article   |    
Effect of Humeral Condylar Resection on Strength and Functional Outcome After Semiconstrained Total Elbow Arthroplasty
Michael D. McKee, MD, FRCS(C); David M.W. Pugh, MD, FRCS(C); Robin R. Richards, MD, FRCS(C); Elizabeth Pedersen, BSc; Caroline Jones, PT; Emil H. Schemitsch, MD, FRCS(C)
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Investigation performed at Upper Extremity Reconstructive Service, Division of Orthopaedics, Department of Surgery,St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

Michael D. McKee, MD, FRCS(C)
David M.W. Pugh, MD, FRCS(C)
Elizabeth Pedersen, BSc
Caroline Jones, PT
Emil H. Schemitsch, MD, FRCS(C)
Upper Extremity Reconstructive Service, Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address for M.D. McKee: mckee@the-wire.com

Robin R. Richards, MD, FRCS(C)Sunnybrook and Women's College Health Sciences Centre and the University of Toronto, 2076 Bayview Avenue, Toronto, ON M4N 3M5, Canada

In support of their research or preparation of this manuscript, one of the authors (E.P.) received grants or outside funding from the St. Michael's Hospital Student Scholarship Fund. None of the authors 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, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

J Bone Joint Surg Am, 2003 May 01;85(5):802-807
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Abstract

Background: Under certain conditions it is standard practice to excise ununited humeral condyles during insertion of a semiconstrained total elbow prosthesis. Since the osseous origins of the common extensors and flexor-pronator muscles are lost, it has been postulated that this excision has a negative effect on strength. We are not aware of any previous study in which this issue has been investigated with use of standardized, objective testing of muscle strength.

Methods: We used objective testing to determine the effect of condylar resection on the muscle strength of the elbow, forearm, wrist, and hand in thirty-two patients who had undergone total elbow arthroplasty. To eliminate bias, the normal, contralateral limb served as the control, and all strength values are given as a percentage of the normal side. The humeral condyles were intact in sixteen patients and had been resected in the other sixteen. Patient demographics were similar in the two groups.

Results: There were no significant differences between the two groups with regard to strength of pronation (103% of the normal side in the group with intact condyles compared with 89% in the group with resection of the condyles; p = 0.40), supination (68% compared with 89%; p = 0.49), wrist flexion (66% compared with 56%; p = 0.46), wrist extension (75% compared with 65%; p = 0.40), or grip strength (83% compared with 72%; p = 0.40). There was also no difference between the two groups with regard to the Mayo Elbow Performance Score (79 points in the group with intact condyles compared with 77 points in the group with resection of the condyles; p = 0.67).

Conclusions: Condylar resection has a minimal, clinically irrelevant effect on forearm, wrist, and hand strength and no effect on the Mayo Elbow Performance Score following total elbow arthroplasty. Thus, the findings of our study support the practice of condylar resection, which simplifies total elbow arthroplasty for many conditions.

Level of Evidence: Therapeutic study, Level III-2 (case series [no, or historical, control group]). 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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