Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-24T05:49:13.209Z Has data issue: false hasContentIssue false
  • English
  • Français

Biomechanical Analysis of Nonconstrained and Semiconstrained Total Elbow Replacements: A Preliminary Report

Published online by Cambridge University Press:  05 May 2011

K.-S. Shih ,
T.-W. Lu ,
Y.-C. Fu ,
S.-M. Hou ,
J.-S. Sun  and
C.-Y. Cheng
K.-S. Shih*
Affiliation:
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan 10617, R.O.C. Orthopaedic Division of Surgical Department, Far Eastern Memorial Hospital, Taipei, Taiwan 22060, R.O.C.
T.-W. Lu*
Affiliation:
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan 10617, R.O.C.
Y.-C. Fu*
Affiliation:
Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan 10617, R.O.C.
S.-M. Hou*
Affiliation:
Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan 10051, R.O.C.
J.-S. Sun*
Affiliation:
Department of Orthopaedic Surgery, Taipei City United Hospital, Taipei, Taiwan 10341, R.O.C.
C.-Y. Cheng*
Affiliation:
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan 33378, R.O.C.
*
*M.D.
**Professor, corresponding author
*M.D.
***Professor
***Professor
*M.D.
Get access

Abstract

The development of elbow arthroplasties has significantly improved the quality of life for many patients suffering from disabling elbow disorders. However, the high complication rate such as loosening and instability limits the long term use of total elbow replacement (TER). In the present study, biomechanical analyses on patients with unilateral nonconstrained (Souter-Strathclyde) and semiconstrained (Coonard-Morrey) TER subjects were performed to investigate differences of their motion patterns under unloaded and loaded conditions. In a biomechanical laboratory, each subject performed vertical and horizontal elbow flexion/extension first without and then with external loading (5 lb). The kinematic data were measured using 3D motion analysis system and the motion axis of the elbow was calculated by a well-defined mathematic model. During these tests, the upperarm was fixed with a special fixation device and their forearms fully supinated. The elbow motion patterns of the affected sides were compared with those of the normal sides and between different conditions. The results revealed that the elbows moved about a relatively fixed axis both in the semiconstrained and nonconstrained groups in the vertical flexion/extension with or without external loading, compatible with the normal elbows. However, the nonconstrained elbows were less stable during horizontal flexion/externsion motion with or without external loading and the elbow axis moved significantly, indicating of less stability. We conclude that this methodology of elbow motion analysis is acceptable and can be widely recommended for total elbow study. Moreover, the nonconstrained TER is less stable than the semiconstrained TER during the horizontal movement, which was compatible with previous clinical results. The patients with nonconstrained TER are suggested to avoid using their elbows in horizontal motion, especially in loaded conditions.

Keywords

Screw axisElbow jointTotal elbow arthroplastyKinematics
Type
Articles
Information
Journal of Mechanics , Volume 24 , Issue 1 , March 2008 , pp. 103 - 110
Copyright
Copyright © The Society of Theoretical and Applied Mechanics, R.O.C. 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.An, K.-N., “Kinematics and Constraint of Total Elbow Arthroplasty,” Journal of Shoulder & Elbow Surgery, 14, pp. 168S–173S (2005).CrossRefGoogle ScholarPubMed
2.Lee, B. P., Adams, R. A. and Morrey, B. F., “Polyethylene Wear After Total Elbow Arthroplasty,” Journal of Bone & Joint Surgery, American Volume, 87, pp. 1080–1087 (2005).Google ScholarPubMed
3.Valstar, E. R., Garling, E. H. and Rozing, P. M., “Micromotion of the Souter-Strathclyde Total Elbow Prosthesis in Patients With Rheumatoid Arthritis 21 Elbows Followed for 2 Years.,” Acta Orthopaedica Scandinavica, 73, pp. 264–272 (2002).CrossRefGoogle ScholarPubMed
4.Hargreaves, D. and Emery, R., “Total Elbow Replacement in the Treatment of Rheumatoid Disease,” Clinical Orthopaedics & Related Research, 366, pp. 61–71, (1999).CrossRefGoogle Scholar
5.O'Driscoll, S. W. and King, G. J., “Treatment of Instability After Total Elbow Arthroplasty,” Orthopedic Clinics of North America, 32, pp. 679–695 (2001).CrossRefGoogle ScholarPubMed
6.Goldberg, V. M., Figgie, H. E., 3rd, Inglis, A. E. and Figgie, M. P., “Total Elbow Arthroplasty,” Journal of Bone & Joint Surgery, American Volume, 70, pp. 778–783 (1988).Google ScholarPubMed
7.London, J. T., “Kinematics of the Elbow,” Journal of Bone & Joint Surgery, American Volume, 63, pp. 529–535 (1981).Google ScholarPubMed
8.Morrey, B. F. and Chao, E. Y., “Passive Motion of the Elbow Joint,” Journal of Bone & Joint Surgery, American Volume, 58, pp. 501–508 (1976).Google ScholarPubMed
9.Bottlang, M., Madey, S. M., Steyers, C.M., Marsh, J. L. and Brown, T. D., “Assessment of Elbow Joint Kinematics in Passive Motion by Electromagnetic Motion Tracking,” Journal of Orthopaedic Research, 18, pp. 195–202(2000)CrossRefGoogle ScholarPubMed
10.Duck, T. R., Dunning, C. E., Armstrong, A. D., Johnson, J. A. and King, G. J. W., “Application of Screw Displacement Axes to Quantify Elbow Instability,” Clinical Biomechanics, 18, pp. 303–310 (2003).CrossRefGoogle ScholarPubMed
11.Ericson, A., Arndt, A., Stark, A., Wretenberg, P. and Lundberg, A., “Variation in the Position and Orientation of the Elbow Flexion Axis,” Journal of Bone & Joint Surgery, British Volume, 85, pp. 538–544 (2003).CrossRefGoogle ScholarPubMed
12.Giesl, P., Meisel, D., Scheurle, J. and Wagner, H., “Stability Analysis of the Elbow with a Load,” Journal of Theoretical Biology, 228, pp. 115–125 (2004).CrossRefGoogle ScholarPubMed
13.Inagaki, K., O'Driscoll, S. W., Neale, P. G., Uchiyama, E., Morrey, B. F. and An, K.-N., “Importance of a Radial Head Component in Sorbie Unlinked Total Elbow Arthroplasty,” Clinical Orthopaedics & Related Research, 400, pp. 123–131 (2002).CrossRefGoogle Scholar
14.O'Driscoll, S. W., An, K. N., Korinek, S. and Morrey, B. F., “Kinematics of Semi-Constrained Total Elbow Arthroplasty,” Journal of Bone & Joint Surgery, British Volume, 74, pp. 297–299 (1992).CrossRefGoogle ScholarPubMed
15.Schuind, F., O'Driscoll, S., Korinek, S., An, K. N. and Morrey, B. F., “Loose-Hinge Total Elbow Arthroplasty. an Experimental Study of the Effects of Implant Alignment on Three-Dimensional Elbow Kinematics,” Journal of Arthroplasty, 10, pp. 670–678 (1995).CrossRefGoogle ScholarPubMed
16.Ring, D., Kocher, M., Koris, M. and Thornhill, T. S., “Revision of Unstable Capitellocondylar (Unlinked) Total Elbow Replacement,” Journal of Bone & Joint Surgery, American Volume, 87, pp. 1075–1079 (2005).Google ScholarPubMed
17.Ramsey, M. L., Adams, R. A. and Morrey, B. F., “Instability of the Elbow Treated with Semiconstrained Total Elbow Arthroplasty,” Journal of Bone & Joint Surgery, American Volume, 81, pp. 38–47 (1999).Google ScholarPubMed
18.Wright, T. W. and Hastings, H., “Total Elbow Arthroplasty Failure Due to Overuse, C-Ring Failure, And/Or Bushing Wear,” Journal of Shoulder & Elbow Surgery, 14, pp. 65–72 (2005).CrossRefGoogle ScholarPubMed
19.King, G. J., Itoi, E., Niebur, G. L., Morrey, B. F. and An, K. N., “Motion and Laxity of the Capitellocondylar Total Elbow Prosthesis,” Journal of Bone & Joint Surgery, American Volume, 76, pp. 1000–1008 (1994).Google ScholarPubMed
20.Ramsey, M., Neale, P. G., Morrey, B. F., O'Driscoll, S. W. and An, K.-N., “Kinematics and Functional Characteristics of the Pritchard ERS Unlinked Total Elbow Arthroplasty,” Journal of Shoulder & Elbow Surgery, 12, pp. 385–390 (2003).CrossRefGoogle ScholarPubMed
21.Gage, J. R., DeLuca, P. A. and Renshaw, T. S., “Gait Analysis: Principle and Applications with Emphasis on its Use in Cerebral Palsy,” Instructional Course Lectures, 45, pp. 491–507 (1996).Google Scholar
22.Kadaba, M. P., Ramakrishnan, H. K. and Wootten, M. E., “Measurement of Lower Extremity Kinematics During Level Walking,” Journal of Orthopaedic Research, 8, pp. 383–392 (1990).CrossRefGoogle ScholarPubMed
23.Sutherland, D. H. and Hagy, J. L., “Measurement of Gait Movements from Motion Picture Film,” Journal of Bone & Joint Surgery, American Volume, 54, pp. 787–797(1972).Google ScholarPubMed
24.Lin, H.-C., Lu, T.-W. and Hsu, H.-C, “Comparisons of Joint Kinetics in the Lower Extremity Between Stair Ascent and Descent,” Journal of Mechanics, 21, pp. 41–45 (2004).CrossRefGoogle Scholar
25.Murray, I. A. and Johnson, G. R., “A Study of the External Forces and Moments at the Shoulder and Elbow While Performing Every Day Tasks,” Clinical Biomechanics, 19, pp. 586–594 (2004).CrossRefGoogle ScholarPubMed
26.Spoor, C. W. and Veldpaus, F. E., “Rigid Body Motion Calculated from Spatial Co-Ordinates of Markers,” Journal of Biomechanics, 13, pp. 391–393 (1980).CrossRefGoogle ScholarPubMed
27.Woltring, H. J., Huiskes, R., de Lange, A. and Veldpaus, F. E., “Finite Centroid and Helical Axis Estimation from Noisy Landmark Measurements in the Study of Human Joint Kinematics,” Journal of Biomechanics, 18, pp. 379–389(1985).CrossRefGoogle Scholar