- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis


Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA



- elbow joint commonly involved

- 90% of haemophiliacs


Acute unreconstructable fracture > 60






Poor soft tissue cover skin triceps


Under 60 years


Charcot Joint


Implant Types


1. Fully Constrained 

- have highest failure


2. Semi- constrained 


Coonrad-Morrey TER

- sloppy hinge

- allow some varus-valgus


3. Unconstrained 



- stems on ulna & humerus to prevent loosening

- poly / metal bearing

- require MCL & LCL for stability


Technique Latitude Total Elbow Replacement


Total Elbow Latitude RATotal Elbow Latitude RA



- can covert unlinked to linked simply at end of case or at later revision by adding anterior O piece

- unconstrained / semiconstrained

- anterior humeral flange with bone graft important for longetivity


Lateral position

- arm over bolster


Posterior Approach

- full thickness skin flaps

- identify and protect ulna nerve with vessiloops


Total Elbow Ulna Nerve


Triceps Options


A. Split in midline

- feathered off bone medially and laterally

- left attached distally


B.  Bryan-Morrey

- triceps elevated from subperiosteally

- from ulna to radial side

- periosteum left attached on radial side


C.  Triceps sparing

- elevate triceps tendon medially and laterally

- identify and protect ulna and radial nerve medially and laterally

- divide collaterals from humerus and dislocate elbow to medial aspect of triceps


Distal Humerus

- elevate and tag LCL / MCL for later repair

- elevate anterior capsule off humerus


Dislocate Elbow


Prepare humerus


1.  Size capitellum and trochlea with spool

- judge off distal humerus

- insert into olecranon and over radial head


2.  Stabilise centre of rotation

- most important

- centre of capitellum to medial epicondyle of trochlea (just distal and anterior to it)

- pass pin through


3.  Resect olecranon fossa, find entry to IM canal

- pass IM guide


4.  Attach resection jig to rotation and IM pins

5.  Drill holes made to establish area to resect with saw

6.  Need to leave medial column (some trochlea) and lateral column (some capitellum)

7.  Trial


Prepare ulna and radius


1.  Broach IM canal of ulna

2.  Pass IM jig, centre on ulna

- EM points towards ulna styloid

- fixed in position with 3 pins

3.  Use jig to 

- resect radial head

- burr prepares ulna lateral to medial

4.  Trial


Humeral / ulna and radius prosthesis inserted

- simplex cement

- cement restrictors



- collateral ligaments reattached through humeral prosthesis

- closure triceps over drain with Ethibond


Post op

- POP 1 - 2 weeks till wound healed




Morrey et al JBJS Am 1998

- TER in rheumatoid arthritis

- followed for 10 years

- 92% survival rate

- 10% incidence of serious complication requiring re-operation

- infection / aseptic loosening / fracture / triceps avulsion / loosening


Morrey et al JBJS Am 2010

- TER in post traumatic arthritis

- 69 patients followed for 9 years

- 19% failure rate

- infection < 5 years, bushing failure 5-10 years, then component loosening

- most patients with failure < 60 years






Total Elbow Replacement InfectionTotal Elbow Joint Infected 2Infected TER



- 4-5%

- most common cause of failure


Risk factors for infection

- previous surgery

- previous infection

- stage IV RA

- drainage post-op

- re-operation for any reason

- poor skin



- Bier's block and IV antibiotics at beginning of case

- POP for 2 weeks post op to achieve wound healing




Often follows superficial infection or bursitis

- need aggressive treatment of any superficial infection

- can often salvage joint with early debridement and washout


If signs of bony infection / loosening 

- 2 stage revision

- resection arthroplasty


Total Elbow Replacement Cement SpacerTotal Elbow Replacement Cement Spacer 2


Intraoperative fracture




More common in unconstrained

- 6%


Transient neuropraxia

- 5%


Triceps failure

- 2%




Revision TER


Total elbow loose humeral component


Periprosthetic Fracture