Indian Journal of Orthopaedics

LETTER TO EDITOR
Year
: 2014  |  Volume : 48  |  Issue : 5  |  Page : 536--537

Author's reply


Suresh Kumar, Sunayan Mahanta 
 Department of Orthopedics, Maharishi Valmiki Hospital, Pooth Khurd, New Delhi, India

Correspondence Address:
Suresh Kumar
C5/109, First Floor, Near Shankar Chowk, Sector-11, Rohini, New Delhi - 110 085
India




How to cite this article:
Kumar S, Mahanta S. Author's reply.Indian J Orthop 2014;48:536-537


How to cite this URL:
Kumar S, Mahanta S. Author's reply. Indian J Orthop [serial online] 2014 [cited 2020 Feb 22 ];48:536-537
Available from: http://www.ijoonline.com/text.asp?2014/48/5/536/139894


Full Text

Sir,

We appreciate your interest [1] in our article [2] titled as "Primary total elbow arthroplasty".

We have not locked the humeral and ulnar components before inserting them into the respective medullary canal; the ulnar component was inserted first then followed by humeral component in all the cases. After cement is hardened, humeral and ulnar components are assembled and fixed with hinge screw which was passed from the medial side of the elbow joint. There are slots on the medial side of the humeral hinge and on the lateral side of the ulnar hinge section which coincides with the slots on either side of the hinge screw and also in the alignment of the lock screw hole. This is confirmed by passing lock screw hole probe from anterior side of the joint laterally. After the confirmation of the lock screw hole, lock screw is passed in its hole and tightened completely. No doubt, working space from the anterior side is little after engaging the two components. However by experience, it becomes easier. Semi constrained\linked implants with pin-stabilized but loose, hinges avoid the potential for dislocation or subluxation. [3],[4],[5] With Linked implants, disassembly of the components or breakage of the axle locking mechanism or disassociation of the components is a rare complication that may be the cause of implant failure. The vertical height of the prosthetic hinge was compared with the gap between the cut ends of the humerus and the ulna in both, extension and flexion. It may be necessary, to resects more bone from the distal humerus to accommodate the hinge, in patients with marked contractures of the flexors and extensors. Four sizes of prostheses are available like; extra small (dimension 13 × 7 mm), small (dimension 14 × 7 mm), medium (15 × 8 mm), large (16 × 8 mm), for right and left side. [3] We have used the different sizes of prostheses depending upon the dimension of the medullary canal of ulna and humerus. We compared the length with the normal side postoperatively.

References

1Khan HA. Primary total elbow arthroplasty. Indian J Orthop 2014;48:In this issue???.
2Kumar S, Mahanta S. Primary total elbow arthroplasty. Indian J Orthop 2013;47:608-14.
3Baksi DP. Sloppy hinge prosthetic elbow replacement for posttraumatic ankylosis or instability. J Bone Joint Surg Br 1998;80:614-9.
4Gill DR, Morrey BF. The Coonrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year followup study. J Bone Joint Surg Am 1998;80:1327-35.
5Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 1992;74:479-90.