This retrospective case series from Mayo Clinic reports outcomes of total elbow replacement (TER) for spontaneously ankylosed or fused elbows in 13 patients. The study addresses a technically demanding indication with limited prior data, following patients for a mean of 12 years. The key question: can a non-custom linked semi-constrained prosthesis provide durable function in the most challenging elbow arthroplasty scenario?
The ankylosed elbow is one of the most challenging indications for TER, and this series provides the longest follow-up data available for this specific indication.
The critical pre-operative conversation is about complications, not motion gains. A re-operation rate exceeding 50% and a mean of 4 additional operations per deep infection means that patients must have realistic expectations before proceeding.
Heterotopic ossification prophylaxis with radiation failed in 3 of 4 patients who received it — this is a humbling reminder that HO prevention in post-traumatic ankylosed elbows remains an unsolved problem.
For younger patients under 60, this series supports TER as preferable to interposition arthroplasty when the elbow is ankylosed, because the linked implant provides stability that deficient ligaments cannot. Interposition arthroplasty requires intact ligamentous support that simply does not exist after the circumferential release needed to mobilise a fused elbow.
The intraoperative technique point worth remembering: up to 2 cm of humeral shortening can buy 15°–20° of extension without cosmetic penalty in these patients.
This retrospective case series from Mayo Clinic reports outcomes of total elbow replacement (TER) for spontaneously ankylosed or fused elbows in 13 patients. The study addresses a technically demanding indication with limited prior data, following patients for a mean of 12 years. The key question: can a non-custom linked semi-constrained prosthesis provide durable function in the most challenging elbow arthroplasty scenario?
The ankylosed elbow is one of the most challenging indications for TER, and this series provides the longest follow-up data available for this specific indication.
The critical pre-operative conversation is about complications, not motion gains. A re-operation rate exceeding 50% and a mean of 4 additional operations per deep infection means that patients must have realistic expectations before proceeding.
Heterotopic ossification prophylaxis with radiation failed in 3 of 4 patients who received it — this is a humbling reminder that HO prevention in post-traumatic ankylosed elbows remains an unsolved problem.
For younger patients under 60, this series supports TER as preferable to interposition arthroplasty when the elbow is ankylosed, because the linked implant provides stability that deficient ligaments cannot. Interposition arthroplasty requires intact ligamentous support that simply does not exist after the circumferential release needed to mobilise a fused elbow.
The intraoperative technique point worth remembering: up to 2 cm of humeral shortening can buy 15°–20° of extension without cosmetic penalty in these patients.