title: Arthroscopically assisted elbow interposition arthroplasty without hinged external fixation: surgical technique and patient outcomes.
abstract: BACKGROUND
  Total elbow arthroplasty is successful in older, lower demand patients but not in the younger, more active individual with severe elbow arthritis. Interposition arthroplasty is an alternative for younger patients who hope to minimize the degree to which arm use is restricted. Interposition arthroplasty traditionally involves release of all ligaments and capsule. As a result, the postoperative care included the use of a hinged external fixator of the elbow to apply distraction and to permit motion during the early phases of healing. We describe a novel surgical technique without a hinged external fixator that allows secure fixation of the interposition graft through arthroscopic assistance and maintains the integrity of the medial collateral ligament with only a takedown and repair of the lateral collateral ligament complex.
  
  
  METHODS
  A retrospective chart review was performed to analyze 4 patients with an average age of 57 years who underwent surgery between 2007 and 2011. The patients were also contacted to assess elbow-specific American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder, and Hand scores.
  
  
  RESULTS
  The average follow-up was 3.6 years (range, 2.5-6 years), and 1 patient was converted to a total elbow arthroplasty after 2.5 years because of persistent pain. The remaining 3 patients have done well with regard to pain control, stability, and functional use of the operative extremity. There were no postoperative complications.
  
  
  CONCLUSIONS
  On the basis of our small series of patients, an arthroscopically assisted elbow interposition arthroplasty without hinged external fixation can provide satisfactory medium-term outcomes as a salvage procedure for a difficult condition with limited options.
authors: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
authors: Aakash
authors: A
authors: Chauhan
authors: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
authors: Bradley A
authors: BA
authors: Palmer
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center CMI, Pittsburgh, PA, USA. Electronic address: mebaratz@gmail.com.
authors: Mark E
authors: ME
authors: Baratz
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D001168:Arthritis / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D017885:Collateral Ligaments / Q000601:surgery; D004551:Elbow Joint / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies
keywords: Achilles allograft; Elbow; arthritis; arthroscopy; interposition arthroplasty; post-traumatic arthritis; rheumatoid arthritis