Total Elbow Arthroplasty: Design Considerations

Total elbow arthroplasty (TEA) designs can be either unlinked or linked semi-constrained with a “sloppy hinge.” Unlinked TEA requires an intact or replaced radial head, good bone stock, and secure ligament repair as joint instability can be problematic. Semi-constrained TEA is preferred if instability or bone loss is present. Convertible designs have the advantage that well-fixed stems do not have to be revised if TEA needs conversion from unlinked to linked due to instability. Implant wear and loosening rates may be reduced by modern TEA designs with more anatomic stem designs, surface roughening, improved linkage mechanisms, and precise surgical guidance for correct implant alignment.