| Popis: |
Primary osteoarthritis (PO) is not a frequent situation in the elbow, more frequent posttraumatic arthritis (PTA) after fracture-dislocation or articular plurifragmentated fracture. Patients with PO are over 50 years old, and patients with PTA are often young workers and sportsmen. For diagnosis in PO, X-rays are sufficient, but for PTA, CT scan and MRI are useful also to evaluate complexity of bone lesion and of soft tissue. Primary joint replacement in PO with a linked total elbow arthroplasty is indicated if the patient is older than 65 years and has aching discomfort most of the time, through the entire arc of movement and at night after using other nonoperative (drugs, infiltration, physical therapy) and operative techniques (loose body removal or arthroscopic debridement, open arthrolysis, etc.) to improve symptoms. Careful attention to surgical technique to recover full extension in operative room and limited postoperative use, however, must be emphasized. Posttraumatic arthritis (PTA) is often quite disabling due to pain and loss of motion; bone deficiency is common, and a flail limb may result from nonunion of a fracture. Such circumstances represent a relative contraindication to prosthesis. Unfortunately, there is no reliable alternative treatment. Prosthetic replacement, especially in the older age group, remains the best treatment, but semiconstrained total elbow arthroplasty in patients with posttraumatic arthritis places high demands on the implant and is associated with a relatively high failure rate. Seventy-five percent of failures occur in patients less than 60 years of age (infection, bushing wear, component loosening, or fracture) for quality of soft tissue after many operations or for returning to strenuous labor or sport against the advice of surgeon. We now impose strict limitations on the use of the limb; heavy work is not allowed, and a lifting limit of 4.5 kg is recommended. In this way prosthetic replacement of the elbow joint has continued to improve over time. Current hot topics in elbow arthroplasty include triceps-preserving exposures, implantation of components with better-expected wear performance, management of the ulnar nerve, prevention of infection, and the development of successful cementless components. |
