The Hip: Preservation, Replacement and Revision

Ulna-Humeral Arthroplasty



- Discussion:
     - see: elbow flexion contracture;
     - indicated for patients w/ loss of motion (out of functional range from 30 to 130 deg) due to anterior and posterior osteophytes;

- PreOp Planning and Positioning:
    - patient is supine w/ bump placed under shoulder, and arm folded across chest;
    - equipment:
          - head light is useful;
          - sterile tourniquet;
          - sharp small straight and curved osteotomes, sharp curved curretes, and strong pituitarys are helpful;
          - bone wax;

- Operative Technique:
    - standard posterior approach to elbow is performed using either triceps spliting or triceps elevating approach;
          - w/ the triceps elevating technique, the ulnar nerve is identified but the cubital tunnel does not have to be released;
    - the tip of the olecranon and any associated osteophytes are removed;
          - take care to avoid injury to articular surface of the trochlea;
    - the olecranon fossa lies just above the trochlear surface, and may contain large amounts of osteophytes;
    - a Cloward drill is placed in the center of the olecranon fossa and 1 sq cm of bone is removed;
          - use of an excessively large Cloward drill may result in humeral fracture;
          - placement of the drill hole too far inferiorly, may invade the anterior trochlear articular surface;
                - some surgeons, place the drill inferiorly (just above the posterior articular surface but aim the drill slightly superiorly, in order to
                        avoid the anterior cartilage);
          - w/ a prominent coronoid osteophyte, it is important not to place the drill hole to far superior, otherwise the surgeon will have to 
                currette out the osteophyte blindly ;
                 - elbow flexion is helpful to bring the coronoid osteophyte close to the drill hole opening;
                 - a currette or small osteotome is then used to remove the osteophyte;
    - bone wax is applied the transected bony surfaces;
    - wound closure include proximal reattachment of the triceps insertion into crossing drill holes into the olecranon, and more distally 
          anchoring the periosteum to the superficial forearm fascia;
          - deep forearm fascia is then securely closed to prevent ulnar subluxation;

- Case Example:
    - 50 year old male who developed atraumatic osteoarthritis of the elbow w/ a ROM from 40 to 120 deg;
    - postoperatively, the patient had a ROM of 5 to 120 deg;

     



    - 40 yr old male who developed atraumatic osteoarthritis of the elbow w/ a resultant ROM of 40 to 110 deg;
    - post-operatively he was able to achieve 20 to 130 deg
   


- Complications:

   

   



Ulnohumeral Arthroplasty: Results in Primary Degenerative Arthritis of the Elbow.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, May 14, 2012 11:28 am