Stiff elbow: distraction interposition arthroplasty with an achilles tendon allograft: long-term radiological and functional results

Abstract

Objective: The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft. Methods: The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients. Mean follow-up period was 87.6 (range: 40 to 131) months. Mean distraction time with an external fixator was 7 (range: 6 to 8) weeks. Elbow motion was allowed in the first postoperative day in all patients. Radiological evaluation was performed pre- and postoperatively. Elbow ROM, and the Mayo Elbow Performance Score (MEPS) and DASH scores were recorded for functional evaluation. Results: Mean preoperative flexion-extension range was 24 degrees (range: 0 to 80 degrees) and mean supination-pronation range was 15 degrees. Two patients had elbow ankylosis in 90 degrees and 60 degrees of flexion at the preoperative examination. Mean postoperative flexion-extension range increased significantly to 81 degrees (range: 50 degrees to 110 degrees) (p<0.05). Mean preoperative DASH score improved from 75.3 (range: 53 to 89) to 18.9 (range: 6.7 to 45.8) postoperatively (p<0.05). Mean postoperative MEPS were poor (mean: 25, range: 20 to 35) while postoperative MEPS were good (mean: 71, range: 70 to 75) in 4 patients and fair in 1 (p<0.05). No patient experienced elbow instability at the final follow-up and none required revision. Conclusion: Distraction interposition arthroplasty is a salvage procedure which appears to have good long-term functional results, especially in patients in which elbow arthroplasty is not suitable. The use of Achilles allograft for interposition can protect the joint space in the long-term.