Abstract
The Schlein total elbow prosthesis has a hinged, semi-constrained structure with stems on both the humeral and the ulnar components. This structure seems to be rather favorable in comparison with a conventional hinged elbow prosthesis such as the McKee and Dee prostheses, but neverthless there are some undesirable points: 1) the intramedullary stems are narrow and short especially in the humeral component, and 2) the HDP (high density polyethylene) bearing insert of the ulnar component tends to dislocate.
Therefore these were compensated for by 1) extending the humeral stem to about 15 cm, fitting a Küntscher nail of 8 mm or 9 mm in diameter; 2) extending, if necessary, the ulnar stem to about 12 cm, fitting a Küntscher nail of 6 mm in diameter; and 3) forming a hook at the HDP tray in order to prevent the dislocation of the HDP bearing insert.
Total elbow replacement using this modified Schlein prosthesis has been performed in six cases. In the three patients with rheumatoid arthritis, a 69-year-old female (7 years from surgery), a 60-year-old female (1 year) and a 56-year-old male (8 months), almost perfect relief from pain was achieved. The improvement of the range of motion was from -70°-100° to -60°-140°, -80°fibrous ankylosis to -70°-130°, and -20°-40° to 0°-130°, respectively. The increase of range of flexion gave great satisfaction to all patients by their reacquisition of the ability to wash their face and feed themselves. They do not show, roentogenologically, either mechanical loosening or breakage of the components, and have had good clinical courses.
