Ch 53 - Total Elbow Replacement

Question 1

What are some recent technoloical advances for total elbow replacements in dogs in general?

Answer 1

• Resurfacing, rather than screwed or stemmed components
• Titanium, rahter than cobalt chrome alloy
• ELetron beam melthing rather than bead sintering for interface surface texture

Question 2

What implant in this?
Decribe some of the features of this implant

Answer 2

5th generation Iowa State TER
- Cemented system
- Cobalt chrome humeral component
- 120deg arc UHMW polyethylene r/u component
- Porpous coated condylar surface for bone ingrowth

Question 3

What impant is this?
Describe some of the features of this implant

Answer 3

TATE 3rd generation
- Press-fit, cementless, resurfacing design
- Titanium 3D printed humeral component and r/u backing
- Titanium nitride coating of articular surface of humeral component
- Hydroxyapatite coating of metal-bone interfaces
- 175 degree arc UHMT polyethylele r/u component with titanium backing
- Less invasive approach, “cartridge implant”
- Posts for primary fixation and porous surface for long term stability

Question 4

What implant is this?
Describe some of the features of this implant

Answer 4

BANC (Biomechanically Anatomic, Nonconstrained and Compartmental)
- Non-cemented, resurfacig design
- UHMW polyethylene conican disc press fitted over titanium cylinder and screwed into capitulum
- Shape-matched polished titaniumhemicircular component
- Primary fixation with large transcondylar screw and 2 smaller ulnar screws

Question 5

What modifications have been made to the TATE elbow?

Answer 5

• Hollow primary fixation posts
• Hydroxyapatite coating
• Reduced prosthetic constraint in rotation and mediolateral translation
• Titanium

Question 6

What modifications have been made to the BANC?

Answer 6

• Increase in transcondylar screw size from 3.8 to 6.4mm
• Larger medial epicondyle screw from 3.0mm to 4.5mm
• Electron beam melting for bone ingrowth

Question 7

What are potential contraindications of a Total Elbow Replacement?

Answer 7

• Bilateral elbow OA (limited revision options)
• Systemic or local infections
• Chronic elbow luxation (including congenital luxation)
• Severe malunion (Iowa state may still be ok)
• Neuro dysfunction
• Skeletally immature

Question 8

What are the main differences in the surgical procendures for the Iowa state, TATE and BANC elbow replacements?

Answer 8

Question 9

What are the main complications seen with the Iowa State system?

Answer 9

Elbow joint luxation and fractures of the ulna

Question 10

What are the main complications seen with the TATE elbow?

Answer 10

• Humeral fractures
• Implant malpositioning or loosening

Major/catastrophic complications range from 4-65%
Steep learning curve

By 6-12 months, peak vertical ground force reaction better than contralateral limb and by 2yr had reached a normal value