This paper catalogs the complications of total elbow arthroplasty from the early Mayo Clinic experience. Complications are classified by required management rather than by implant design. It compares loosening, instability, infection, and nerve and triceps problems across constrained, semiconstrained, and resurfacing prostheses.
The central lesson is a mechanical one: implant constraint dictates the failure mode. A rigid hinge cannot absorb the cyclic anteroposterior force of the elbow, so it transmits load straight to the bone-cement interface and loosens (>25% by 3 years). Loosen the constraint and soft tissue shares the load, but go too far to a resurfacing design and you trade loosening for instability.
This framework still guides implant selection. Modern practice favors semiconstrained (linked) designs for most reconstructions, exactly the direction this paper pointed toward.
Two technical pearls remain directly actionable. Postoperative ulnar motor weakness beyond 12 hours warrants exploration, and a triceps-sparing approach nearly eliminates extensor insufficiency. Also remember the elbow's higher infection rate (4-9%) reflects thin soft-tissue coverage and a high-risk RA population.
This paper catalogs the complications of total elbow arthroplasty from the early Mayo Clinic experience. Complications are classified by required management rather than by implant design. It compares loosening, instability, infection, and nerve and triceps problems across constrained, semiconstrained, and resurfacing prostheses.
The central lesson is a mechanical one: implant constraint dictates the failure mode. A rigid hinge cannot absorb the cyclic anteroposterior force of the elbow, so it transmits load straight to the bone-cement interface and loosens (>25% by 3 years). Loosen the constraint and soft tissue shares the load, but go too far to a resurfacing design and you trade loosening for instability.
This framework still guides implant selection. Modern practice favors semiconstrained (linked) designs for most reconstructions, exactly the direction this paper pointed toward.
Two technical pearls remain directly actionable. Postoperative ulnar motor weakness beyond 12 hours warrants exploration, and a triceps-sparing approach nearly eliminates extensor insufficiency. Also remember the elbow's higher infection rate (4-9%) reflects thin soft-tissue coverage and a high-risk RA population.