Chapter 4 Total Elbow Arthroplasty
Surgical Overview
• TEA includes three types of implants: constrained, nonconstrained, and semiconstrained.
1 The first prosthesis developed was rigid and fully constrained. It had a metal-to-metal interface and provided immediate stability, but had a high failure rate with loosening occurring after several years.
2 This was followed by a nonconstrained implant, which is composed of two separate units and is a resurfacing of the distal humerus and proximal ulna.
– This design requires strong ligaments, good bone quality, and adequate soft tissue support and is therefore only indicated in a select group of patients.
• The choice for a specific implant is based on the extent and cause of the disease, the specific needs of the patient, and the surgeon’s preference.
Rehabilitation Overview
• Progression of therapy is based on the stages of wound healing and is affected by implant type, skin integrity, rate of healing, and the preoperative and postoperative condition of the triceps.
• Timeframes may be delayed to allow for wound closure and adequate healing of the triceps in patients with poor soft tissue quality, as is common in rheumatoid arthritis (RA).
• Each surgeon has different preferences in the type of implant, surgical technique, and postoperative treatment. The referring surgeon is consulted for specific range of motion (ROM) restrictions and time frames.
• The guidelines below are for semiconstrained total elbow replacements performed with the triceps sparing approach.
1 This technique was developed to avoid complications such as triceps avulsion, triceps weakness, and wound healing problems.
Postoperative Phase I: Inflammation/Protection (Weeks 0 to 2)
