Total Elbow Arthropasty (TEA) 24363

synonyms:TEA, total elbow replacement, total elbow arthroplasty, TER

TEA CPT

• 24363  
• 24586 

TEA Indications

• Elbow arthritis
• Distal humerus fracture in elderly, low demand patient. (Frankle MA, JOT 2003;17:473).

TEA Contraindications

• Infection
  

TEA Alternatives

• Conservative care
• Elbow fusion

TEA Pre-op Planning / Special Considerations

• Linked semi-constrained TEA:Zimmer Conrad-Morrey 
• Discovery total elbow arthroplasty DJO Surgical
• Nexel ZimmerBiomet total elbow arthroplasty
• Lattitude EV total elbow arthroplasty Wright.com

TEA Technique

• Pre-operative antibiotics, +/- regional block
• General endotracheal anesthesia
• position. All bony prominences well padded.
• Examination under anesthesia.
• Prep and drape in standard sterile fashion.
• Irrigate.
• Close in layers.

TEA Complications

• loosening, poly wear
• poly wear can be managed by bushing exchange for pts with semiconstrained liked TEA.  Poly wear is more common in young active pts who should be cautioned about recommended activity limitions and lifting restrictions.  (Lee BP. JBJS 2005;87A;1080-87)
• Periprosthetic Infection

TEA Follow-up care

• 5-kg permanent lifting restriction.
• AAOS Post Arthroplasty Antibiotic Prophylaxis recommendations for elective procedures.

TEA Outcomes

• Outcome Measures: Mayo Elbow Performance Index (Frankle MA, JOT 2003;17:473).
• 93% good/excellent outcomes, 22% revision rate for TEA in patients <40yrs old. Revision rate is higher for post-traumatic arthritis patients (Celli A, JBJS 2009;91A:1414).

TEA Review References

• Operative Elbow Surgery: Expert Consult: 2012
• AAOS/ASES Advanced Reconstruction Elbow, 2007
• Orthopaedic Knowledge Update: Shoulder and Elbow 3, 2008