Elbow arthroplasty in perspective

This thesis focuses on the effect of biomechanical aspects of prosthesis design and outcome after radial head and total elbow arthroplasty.
First, we examine the available evidence regarding the role of several unfavorable biomechanical conditions about the elbow in the development of osteoarthritis. We conclude that biomechanical factors do indeed play a role in the development of osteoarthritis of the elbow, but that the pathophysiological mechanisms are complex and not fully understood to date. Post-traumatic osteoarthritis seems to be more a mechanically induced biological problem than a biomechanical problem per se. Instability seems to play a role, although its relation with osteoarthritis is not yet clearly defined. The roles of cartilage defects and untreated osteochondritis dissecans remain unclear.
Second, we analyze the mid-term results after both cemented and press-fit bipolar radial head arthroplasty (RHA). We also report the results of a systematic review of the literature on RHA. Additionally, the outcomes after monopolar metallic RHA as treatment of chronic longitudinal radioulnar dissociation (LRUD) are analyzed. We conclude that the mid-term results after both cemented and press-fit RHA are favorable. There is no evidence that prosthesis design characteristics affect outcome after RHA. Bipolar prostheses seem to be able to compensate, to some extent, for radiocapitellar malalignment. Metallic monoblock RHA does not reliably address the functional deficiency from chronic LRUD.
Third, we investigate the occurrence of metallosis after Kudo TEA and the option to use clinical and laboratory parameters as screening tools for metallosis after TEA. We conclude that metallosis after Kudo TEA is indeed a problem of significance and this metallosis cannot be screened for by means of clinical and laboratory parameters.