Dee R
Clin Orthop Relat Res. 1982 Oct(170):196-203.
Elbow arthroplasty should only be undertaken by surgeons who have considerable experience in total arthroplasty and special training in upper-extremity surgery. The failed total prosthesis presents a formidable challenge. The recognition of this fact fortunately has had an impact on prosthetic design, so that less bone stock is removed at surgery. In addition, second- and third-generation arthroplasties are becoming available that biomechanically are more suitable and that may be expected to be somewhat more durable than those of the first generation. Early and decisive action is recommended in the case of the loose elbow joint prosthesis before the cement mantle causes further abrasive wear to the cortex, which eventually may be broken through, rendering revision much more difficult. If there is any doubt about the adequacy of the bone stock to receive a further prosthesis after removal of the failed joint, a nonprosthetic salvage procedure, or, alternatively, revision as a two-stage procedure is recommended. In the case of the failed surface implant, nonprosthetic interposition arthroplasty will usually give a satisfactory result.
肘关节置换术应由在全关节置换方面有丰富经验且接受过上肢手术专项培训的外科医生来实施。全关节假体失败是一项艰巨的挑战。幸运的是，对这一事实的认识已对假体设计产生影响，因此手术中去除的骨量减少。此外，第二代和第三代关节置换术已面市，它们在生物力学方面更合适，预计比第一代更耐用。对于松动的肘关节假体，在骨水泥套对皮质骨造成进一步磨损之前（最终可能导致皮质骨穿透，使翻修手术难度大大增加），建议尽早采取果断行动。如果在去除失败关节后，对于剩余骨量是否足以植入新的假体存在疑问，建议采用非假体挽救手术，或者分两阶段进行翻修手术。对于表面植入物失败的情况，非假体间置关节成形术通常会取得满意的效果。
