Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Unlinked and Convertible Total Elbow Arthroplasty

비연결형 및 전환형 주관절 전치환술

  • Moon, Jun-Gyu (Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine) ;
  • Chun, Sung-Kwang (Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine)
  • 문준규 (고려대학교 의과대학 구로병원 정형외과학교실) ;
  • 천성광 (고려대학교 의과대학 구로병원 정형외과학교실)
  • Received : 2013.10.02
  • Accepted : 2013.11.04
  • Published : 2013.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Designs of total elbow arthroplasty have been evolving with clinical experiences. Newer implants are expected to resolve current limitations and improve long term outcomes. This review article focuses on the basic knowledge of unlinked and convertible total elbow arthroplasty. There have been a variety of designs of unlinked total elbow prostheses. Some implants are still used in the market, while others are no longer commercially available. Modified and newer designs include more congruent contact surface, stemmed implant, and radiocapitellar arthroplasty. Two convertible elbow prostheses have been developed, and one implant is currently available in Korea. Conversion from an unlinked to a linked mode is performed by adding a linking cap. Unlinked total elbow arthroplasty, which restores native elbow kinematics, has a biomechanical rationale of lowering polyethylene wear and loosening of implants. It can be indicated in younger and higher demand patients, who have adequate bone stock and soft tissues. Convertible total elbow arthroplasty broadens implant selection and simplifies revision surgery. These newer prostheses possibly improve the long term outcomes and resolve disadvantages of linked prostheses in total elbow arthroplasty.

주관절 전치환술은 과거 임상적 결과를 토대로 새로운 디자인이 개발 중이며 불안정성이나 해리 등의 단점을 개선하고 수명을 향상시킬 수 있을 것으로 기대된다. 본 종설은 비연결형 주관절 치환술과 전환형 주관절 치환술의 일반적 개념을 기술하고자 한다. 과거의 비연결형 치환물 중 현재는 일부만 사용되고 있다. 기존의 단점을 보완한 최근의 비연결형 디자인은 더 안정적인 관절면 모양, 스템형 치환물 및 요골-소두 치환술을 첨가하는 형태 등으로 개선되고 있다. 전환형 디자인은 전세계적으로 두 개의 모델이 개발되어 사용 중이며 최근 국내에서도 사용 가능하게 되었다. 비연결형 디자인에서 추가적인 연결고리를 이용하면 쉽게 연결형으로 전환이 가능하다. 비연결형 주관절 치환술은 인체 주관절과 유사한 운동 구조를 가지게 되어 폴리에틸렌 마모나 치환물의 해리를 감소시킬 수 있는 장점이 있다. 주변골과 연부 조직이 보존된 경우 또는 활동도가 높은 젊은 환자에서 적응증이 될 수 있다. 전환형 주관절 치환술은 치환물의 선택을 넓히고 재수술을 용이하게 하는 장점을 가지고 있다. 두 개의 치환물의 사용은 연결형 치환술이 가지고 있는 단점을 보완하고 장기적인 결과를 향상시킬 수 있을 것으로 기대된다.

Keywords

References

  1. Morrey BF, Bryan RS, Dobyns JH, Linscheid RL. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am. 1981;63: 1050-63. https://doi.org/10.2106/00004623-198163070-00002
  2. Brumfield RH, Jr., Volz RG, Green JF. Total elbow arthroplasty: a clinical review of 30 cases employing the Mayo and AHSC prostheses. Clin Orthop Relat Res. 1981;158:137-41.
  3. Kim JM, Lee SM, Park JC, et al. Complication and revision rate as the type of prosthesis of total elbow replacement: Long term follow up in Korea. J Korean Orthop Assoc. 2010;45:10-5. https://doi.org/10.4055/jkoa.2010.45.1.10
  4. Dee R. Total replacement arthroplasty of the elbow for rheumatoid arthritis. J Bone Joint Surg Br. 1972; 54:88-95.
  5. Ewald FC, Scheinberg RD, Poss R, Thomas WH, Scott RD, Sledge CB. Capitellocondylar total elbow arthroplasty. J Bone Joint Surg Am. 1980;62:1259-63. https://doi.org/10.2106/00004623-198062080-00004
  6. Gramstad GD, King GJ, O’Driscoll SW, Yamaguchi K. Elbow arthroplasty using a convertible implant. Tech Hand Up Extrem Surg. 2005;9:153-63. https://doi.org/10.1097/01.bth.0000181293.38237.f0
  7. Morrey BF, Sanchez-Sotelo J. The elbow and its disorders. 4th ed. Philadelphia: Saunders; 2009. 705-910.
  8. Ramsey M, Neale PG, Morrey BF, O'Driscoll SW, An KN. Kinematics and functional characteristics of the Pritchard ERS unlinked total elbow arthroplasty. J Shoulder Elbow Surg. 2003;12:385-90. https://doi.org/10.1016/S1058-2746(02)86885-9
  9. Ring D, Kocher M, Koris M, Thornhill TS. Revision of unstable capitellocondylar (unlinked) total elbow replacement. J Bone Joint Surg Am. 2005;87: 1075-9. https://doi.org/10.2106/JBJS.D.02449
  10. Tanaka N, Kudo H, Iwano K, Sakahashi H, Sato E, Ishii S. Kudo total elbow arthroplasty in patients with rheumatoid arthritis: a long-term follow-up study. J Bone Joint Surg Am. 2001;83:1506-13. https://doi.org/10.2106/00004623-200110000-00008
  11. van der Lugt JC, Geskus RB, Rozing PM. Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. J Bone Joint Surg Am. 2004;86:465-73. https://doi.org/10.2106/00004623-200403000-00002
  12. van Riet RP, Morrey BF, O’Driscoll SW. The Pritchard ERS total elbow prosthesis: lessons to be learned from failure. J Shoulder Elbow Surg. 2009; 18:791-5. https://doi.org/10.1016/j.jse.2008.11.014
  13. King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty. 2001;16:112-6. https://doi.org/10.1054/arth.2001.16499
  14. King GJ, Zarzour ZD, Rath DA, Dunning CE, Patterson SD, Johnson JA. Metallic radial head arthroplasty improves valgus stability of the elbow. Clin Orthop Relat Res. 1999;368:114-25.
  15. Van Riet RP, Van Glabbeek F, Neale PG, Bortier H, An KN, O'Driscoll SW. The noncircular shape of the radial head. J Hand Surg Am. 2003;28:972-8. https://doi.org/10.1016/S0363-5023(03)00426-X
  16. Popovic N, Lemaire R, Georis P, Gillet P. Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am. 2007;89:2469-76. https://doi.org/10.2106/JBJS.F.00723
  17. Little CP, Graham AJ, Karatzas G, Woods DA, Carr AJ. Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative study of three implants. J Bone Joint Surg Am. 2005;87:2439-48. https://doi.org/10.2106/JBJS.D.02927
  18. Wright TW, Wong AM, Jaffe R. Functional outcome comparison of semiconstrained and unconstrained total elbow arthroplasties. J Shoulder Elbow Surg. 2000;9:524-31. https://doi.org/10.1067/mse.2000.109408
  19. Leclerc A, King GJ. Unlinked and convertible total elbow arthroplasty. Hand Clin. 2011;27:215-27. https://doi.org/10.1016/j.hcl.2011.01.003
  20. King GJ, Itoi E, Niebur GL, Morrey BF, An KN. Motion and laxity of the capitellocondylar total elbow prosthesis. J Bone Joint Surg Am. 1994;76: 1000-8. https://doi.org/10.2106/00004623-199407000-00007