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Linked Total Elbow Arthroplasty
The design of total elbow implants has evolved over time, from the simple hinge total elbow implant of the early 1970s that resulted in high rates of early loosening to the resurfacing and linked total elbow (sloppy hinge) implants used today. Currently, total elbow implants are categorized as linked, unlinked, or convertible. The sloppy hinge total elbow implant allows for 8° of varus/valgus laxity. The potential advantage of unlinked total elbow implants is the reduction of forces at the bone-cement interface with diminished loosening; however, unlinked total elbow implants have experienced higher complication rates compared with linked designs and no advantage with respect to implant survivorship. Ulnohumeral instability is a particular risk of unlinked total elbow implants, particularly when the ligaments or the radial head are compromised. Convertible total elbow implants allow for conversion from an unlinked to a linked construct, which can be useful when an unlinked elbow is unstable. Currently, it is unclear whether the most recently designed convertible unlinked implants represent an advantage over current linked designs that warrants the increased risk of instability. Uncemented total elbow implants and hemiarthroplasty elbow implants currently are not cleared for use in the United States.