Purpose
The goal of this study was to test a novel uncemented and unconstrained total elbow
arthroplasty (Kaufmann total elbow) design that is stabilized through a ligament reconstruction.
Methods
We quantified the implant stability after 25,000 cycles, which represents the time
between implantation and when ligament and bone healing has occurred. We used an active
motion experimental setup that applies tendon loads via pneumatic cylinders and reproduces
the forearm-originating dynamic stabilizers of the elbow. The novel total elbow arthroplasty
was actuated for 5,000 full flexion-extension cycles at 5 different shoulder positions.
Four Sawbones and 4 cadaver elbows were employed. Angular laxity and implant stability
were recorded prior to testing and after each 5,000-loading cycle.
Results
Four Sawbones and 4 cadaver elbows were implanted with the uncemented total elbow
arthroplasty and did not demonstrate fixation failure or substantial laxity after
25,000 cycles of loading imparted at different shoulder positions.
Conclusions
Our findings demonstrate that the Kaufmann total elbow replacement implanted into
cadaver and Sawbones specimens did not exhibit fixation failure or excessive laxity
after 25,000 cycles.
Clinical relevance
An uncemented, nonmechanically linked total elbow arthroplasty that gains component
fixation using intramedullary screws and employs a ligament reconstruction to stabilize
the elbow has the potential to be a valuable management option, particularly in younger
patients.
Key words
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References
- Kinematics of semi-constrained total elbow arthroplasty.J Bone Joint Surg Br. 1992; 74: 297-299
- Elbow biomechanics: soft tissue stabilizers.J Hand Surg Am. 2020; 45: 140-147
- Malrotation of the humeral component of the capitellocondylar total elbow replacement is not the sole cause of dislocation.J Orthop Res. 1994; 12: 665-671
- Stability of the unlinked latitude total elbow prosthesis: a biomechanical in vitro analysis.Clin Biomech (Bristol, Avon). 2013; 28: 502-508
- The effect of implant linking and ligament integrity on humeral loading of a convertible total elbow arthroplasty.Shoulder Elbow. 2019; 11: 45-52
- Role of collateral ligaments in the GSB-linked total elbow prosthesis.J Shoulder Elbow Surg. 2001; 10: 260-264
- Kinematics and functional characteristics of the Pritchard ERS unlinked total elbow arthroplasty.J Shoulder Elbow Surg. 2003; 12: 385-390
- Motion and laxity of the capitellocondylar total elbow prosthesis.J Bone Joint Surg Am. 1994; 76: 1000-1008
- Articular and ligamentous contributions to the stability of the elbow joint.Am J Sports Med. 1983; 11: 315-319
- Kinematic and stability of the Norway elbow. A cadaveric study.Acta Orthop Scand. 1993; 64: 657-663
- Importance of a radial head component in Sorbie unlinked total elbow arthroplasty.Clin Orthop Relat Res. 2002; 400: 123-131
- Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog.J Bone Joint Surg Am. 1993; 75: 1795-1803
- Tendon healing in a bone tunnel. Part I: biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.Arthroscopy. 2002; 18: 113-123
- Kinematics and laxity of a linked total elbow arthroplasty following computer navigated implant positioning.Comput Aided Surg. 2012; 17: 249-258
- The effect of implant malalignment on joint loading in total elbow arthroplasty: an in vitro study.J Shoulder Elbow Surg. 2012; 21: 1032-1038
- Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative study of three implants.J Bone Joint Surg Am. 2005; 87: 2439-2448
- Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project.Acta Orthop. 2013; 84: 119-123
- Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008.J Shoulder Elbow Surg. 2014; 23: 829-836
- Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register.Acta Orthop. 2009; 80: 472-477
- Development of an active elbow flexion simulator to evaluate joint kinematics with the humerus in the horizontal position.J Biomech. 2010; 43: 2114-2119
- Rehabilitation of the medial collateral ligament-deficient elbow: an in vitro biomechanical study.J Hand Surg Am. 2000; 25: 1051-1057
- Application of screw displacement axes to quantify elbow instability.Clin Biomech (Bristol, Avon). 2003; 18: 303-310
- Muscle forces and pronation stabilize the lateral ligament deficient elbow.Clin Orthop Relat Res. 2001; 388: 118-124
- Rehabilitation of the medial- and lateral collateral ligament-deficient elbow: an in vitro biomechanical study.J Hand Ther. 2012; 25 (quiz 373): 363-372
- Biomechanical study of ligaments around the elbow joint.Clin Orthop Relat Res. 1991; 271: 170-179
- Review paper: absorbable polymeric surgical sutures: chemistry, production, properties, biodegradability, and performance.J Biomater Appl. 2010; 25: 291-366
- In vivo and in vitro degradation of monofilament absorbable sutures, PDS and Maxon.Biomaterials. 1990; 11: 41-45
- Surgical reconstructions for posterolateral rotatory instability of elbow using a synthetic ligament.Shoulder Elbow. 2013; 5: 251-255
- Biomechanical analysis of medial collateral ligament reconstruction grafts of the elbow.Am J Sports Med. 2008; 36: 728-732
- Intrinsic constraint of unlinked total elbow replacements—the ulnotrochlear joint.J Bone Joint Surg Am. 2005; 87: 2019-2027
- Muscle strengths and musculoskeletal geometry of the upper limb.Eng Med. 1979; 8: 41-48
- The derivation of elbow joint forces, and their relation to prosthesis design.J Med Eng Technol. 1979; 3: 229-234
- Elbow joint force predictions for some strenuous isometric actions.J Biomech. 1980; 13: 765-775
- Elbow joint biomechanics for preclinical evaluation of total elbow prostheses.J Biomech. 2013; 46: 2331-2341
- Electromyographic analysis of muscles across the elbow joint.J Orthop Res. 1987; 5: 529-538
Article info
Publication history
Published online: December 13, 2021
Accepted:
October 6,
2021
Received:
December 3,
2020
Footnotes
Dr Kaufmann owns Arrch Orthopedics that has developed this novel elbow arthroplasty. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
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