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.