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Revision of Unstable Capitellocondylar (Unlinked) Total Elbow Replacement
David Ring, MD1; Mininder Kocher, MD2; Mark Koris, MD3; Thomas S. Thornhill, MD3
1 Massachusetts General Hospital, Yawkee Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address: dring@partners.org
2 Children's Hospital and Medical Center, 300 Longwood Avenue, Boston, MA 02115
3 Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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.
Investigation performed at Brigham and Women's Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 May 01;87(5):1075-1079. doi: 10.2106/JBJS.D.02449
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Background: Instability is a recognized complication associated with unlinked total elbow implants. The best form of treatment of this problem is uncertain as very little has been written about it.

Methods: Twelve patients underwent operative treatment of instability at the site of a capitellocondylar unlinked total elbow replacement, and the results were reviewed retrospectively. The study group included ten women and two men with an average age of fifty-eight years. Ten patients had rheumatoid arthritis. Three elbows underwent conversion to a semiconstrained hinged prosthesis. In the other nine elbows, an attempt was made to continue with an unlinked prosthesis: three had reconstruction of one or both collateral ligaments, four had component revision, and two had both ligament reconstruction and component revision.

Results: After an average duration of follow-up of six years (range, two to fifteen years) only three patients had retained a functioning unlinked prosthesis. Of the remaining nine patients, three had had a conversion to a semiconstrained arthroplasty at the time of the index procedure, four had had a conversion to a semiconstrained prosthesis at the time of a salvage procedure, one had had a resection arthroplasty, and one had a painfully dislocated elbow and had declined revision. Thus, seven elbows eventually underwent conversion to a semiconstrained prosthesis; these conversion procedures were technically difficult, with perforation of the humerus occurring in six patients and perforation of the ulna occurring in four. After all procedures, the average elbow flexion was 132° and the average flexion contracture was 25°. According to the Mayo Elbow Performance Index, there were four excellent results, three good results, three fair results, and one poor result.

Conclusions: Revision of an unlinked total elbow prosthesis to a linked total elbow prosthesis is difficult, but it restores elbow function. Although the present series documents the unpredictability of attempts to salvage an unstable unlinked prosthesis, it seems reasonable to attempt at least one soft-tissue procedure before converting to a linked prosthesis.

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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