Ellenbogenendoprothetik: Indikationen, Verfahren und Ergebnisse

Abstract

Total elbow arthroplasty (TEA) is a reliable choice in treating inflammatory and posttraumatic osteoarthritis as well as complex fractures of the elbow, especially in non-reconstructable distal humeral fractures of the elderly. Newer prosthesis designs use a semi-constrained mechanism that has in-built sloppy hinges (varus/valgus mobility. Triceps-on approaches should be preferred whenever possible to avoid postoperative triceps insufficiency. Current 10-year survival rates of 90% have been reported. A TEA leads to reduction of pain levels and to a satisfactory range of motion. The most common complications are infections, aseptic loosening, joint instability and implant failure. Radial head replacement is commonly used for treatment of non-reconstructable radial head fractures but can also be performed in case of posttraumatic osteoarthritis. A monopolar, long stem, non-cemented prosthesis is preferred in the acute situation at our institution. The Kocher approach allows good exposure of the lateral elbow and can thereby help to avoid overstuffing. Recent studies have shown good to excellent clinical outcomes in 70–90% of cases. The most common complications are overstuffing, infections, implant failure and posttraumatic osteoarthritis.