Complications of total elbow arthroplasty.

The need for revision surgery for loosening exceeds 25% with tightly constrained prostheses but is much less with the semiconstrained designs. Resurfacing prostheses may be unstable if not adequately balanced by static and dynamic soft-tissue constraints. Infection is excessive (4%-9%), but resection arthroplasty is a reasonably good salvage procedure. Implant failure is rare. The ulnar nerve is subject to transient (10%) or, occasionally, partial dysfunction. Routine anterior translocation has been beneficial, but there is considerable variation in technique in this regard. Triceps insufficiency can be virtually eliminated with the Kocher lateral-to-medial or the Bryan lateral-to-medial triceps-sparing approach. Fractures of the ulna usually can be treated by cast application, but humeral fractures may require revision surgery because of component loosening. Some complications are decreasing in frequency, whereas others are becoming more widely appreciated. The procedure remains a challenging one, and is one that should be performed by those who are experienced in elbow surgery and who have a detailed knowledge of the numerous potential pitfalls.