Neuropathy in Elbow Arthroplasty

Elbow arthroplasty treats irreversible dysfunction of the elbow joint. The standard operation procedures, which date from 1930, include synovectomy, intra-articular debridement, interposition arthroplasty and total elbow replacement (TER). The value and rationale of TER with prosthesis is well established., as are the indications, relative indications, and contraindications in the young and the elderly. There are four designs of TER: Interposition arthroplasty, fully constrained, semi-constrained, and non-constrained. Semi-constrained TER, whichpermits some motional freedom,. is currently the most popular design. While the long-term prognosis of TER are good, complications include infection, loosening, and neuropathy. The latter damage to the nervous system is rather unique to replacement surgeries and occurs in a high incidence of TERs. The role of TER in exacerbating or causing neuropathy is unclear. To more conclusively evaluate TER and neuropathy, we collected 49 TER elbows on 44patients from 1990 to 1999 at a single medical center. Alloperations involved the split of triceps muscle universally. The choices of implant included 30 elbows of non-constrained type (Souter-strathclyde type) and 19 elbows of semi-con-strained type (Morrey type). Nerve conduction velocity examination revealed 10 incidents of neuropathy in the 49 TER elbows(20%).Three of the neuropathies were radial and seven were ulnar. In addition, five of the cases suffered neurological deficit lasting over six months. Thorough pre-operation neurological examination, careful and gentle intra-operational soft tissue management, reduction of operation time and radical hemostatic procedure are suggested for TER operations.

並列關鍵字

arthroplasty ； total elbow replacement ； neuropathy

國際替代計量

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