title: Stiff elbow: distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft.
  
  
  METHODS
  The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients. Mean follow-up period was 87.6 (range: 40 to 131) months. Mean distraction time with an external fixator was 7 (range: 6 to 8) weeks. Elbow motion was allowed in the first postoperative day in all patients. Radiological evaluation was performed pre- and postoperatively. Elbow ROM, and the Mayo Elbow Performance Score (MEPS) and DASH scores were recorded for functional evaluation.
  
  
  RESULTS
  Mean preoperative flexion-extension range was 24° (range: 0° to 80°) and mean supination-pronation range was 15°. Two patients had elbow ankylosis in 90° and 60° of flexion at the preoperative examination. Mean postoperative flexion-extension range increased significantly to 81° (range: 50° to 110°) (p<0.05). Mean preoperative DASH score improved from 75.3 (range: 53 to 89) to 18.9 (range: 6.7 to 45.8) postoperatively (p<0.05). Mean postoperative MEPS were poor (mean: 25, range: 20 to 35) while postoperative MEPS were good (mean: 71, range: 70 to 75) in 4 patients and fair in 1 (p<0.05). No patient experienced elbow instability at the final follow-up and none required revision.
  
  
  CONCLUSIONS
  Distraction interposition arthroplasty is a salvage procedure which appears to have good long-term functional results, especially in patients in which elbow arthroplasty is not suitable. The use of Achilles allograft for interposition can protect the joint space in the long-term.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Erşen
authors.affiliation: Koç University, School of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirhan
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Ata Can
authors.initials: AC
authors.lastname: Atalar
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Salduz
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Tunalı
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D064591:Allografts; D001178:Arthroplasty / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome