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
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.