The increased utilization of total elbow replacements has resulted in a correspondingly increased number of failed implants requiring revision. The most common reason for revision is aseptic loosening of the ulnar component due to polyethylene induced osteolysis. Implant malalignment is thought to be an important cause of bearing wear and implant failure. The ulnar flexion axis can be used to accurately align the ulnar component of the elbow implant; however, the optimal method of determining this axis intra-operatively is unknown. This in vitro study determined the relationship amongst kinematically and anatomically defined ulnar flexion axes in an effort to improve the accuracy of ulnar component positioning. Five different techniques were used to determine the ulnar flexion axis in 12 cadaveric specimens, 3 kinematic and 2 anatomic. The techniques were compared with the screw displacement axis from simulated elbow flexion. An anatomic measurement technique using the guiding ridge of the greater sigmoid notch of the ulna and the radial head was found to most accurately replicate the position and orientation of the screw displacement axis of the elbow . Because an anatomically derived flexion axis can be determined using both pre-operative imaging techniques, as well as with intra-operative guides, it is more practical than kinematically derived techniques requiring tracking systems for clinical application and should provide reliable and consistent results.
Skip Nav Destination
e-mail: gking@uwo.ca
Article navigation
February 2009
Research Papers
Defining the Flexion-Extension Axis of the Ulna: Implications for Intra-Operative Elbow Alignment
James R. Brownhill,
James R. Brownhill
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Search for other works by this author on:
Louis M. Ferreira,
Louis M. Ferreira
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Search for other works by this author on:
James E. Pichora,
James E. Pichora
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Search for other works by this author on:
James A. Johnson,
James A. Johnson
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, Department of Surgery, and Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Search for other works by this author on:
Graham J. W. King
Graham J. W. King
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
e-mail: gking@uwo.ca
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Surgery, and Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Search for other works by this author on:
James R. Brownhill
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Louis M. Ferreira
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, The University of Western Ontario
, London, ON, N6A 4L6, Canada
James E. Pichora
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canada
James A. Johnson
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Biomedical Engineering, Department of Surgery, and Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canada
Graham J. W. King
Bioengineering Research Laboratory, The Hand and Upper Limb Center,
St. Joseph’s Health Care London
, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Department of Surgery, and Department of Medical Biophysics, The University of Western Ontario
, London, ON, N6A 4L6, Canadae-mail: gking@uwo.ca
J Biomech Eng. Feb 2009, 131(2): 021005 (5 pages)
Published Online: December 10, 2008
Article history
Received:
February 7, 2008
Revised:
September 25, 2008
Published:
December 10, 2008
Citation
Brownhill, J. R., Ferreira, L. M., Pichora, J. E., Johnson, J. A., and King, G. J. W. (December 10, 2008). "Defining the Flexion-Extension Axis of the Ulna: Implications for Intra-Operative Elbow Alignment." ASME. J Biomech Eng. February 2009; 131(2): 021005. https://doi.org/10.1115/1.3005203
Download citation file:
Get Email Alerts
Cited By
Related Articles
Human Joint Simulation Using LifeMOD Co-Simulation
J. Med. Devices (June,2008)
Real-Time, In Vivo Measurement of Contact Pressures at a Knee Arthroplasty
J. Med. Devices (June,2009)
Novel re-entrant porous composite structure: a potential for orthopaedic applications
J. Med. Devices (June,2008)
Design Concept for a Total Knee Replacement with Condylar Guiding Features
J. Med. Devices (June,2011)
Related Proceedings Papers
Related Chapters
Study on Screw Drill Wear When Drilling Low Carbon Stainless Steel and Accompanying Phenomena in the Cutting Zone
International Conference on Instrumentation, Measurement, Circuits and Systems (ICIMCS 2011)
Accuracy of an Axis
Mechanics of Accuracy in Engineering Design of Machines and Robots Volume I: Nominal Functioning and Geometric Accuracy
Friction and Wear of Polymers and Composites
Tribology of Mechanical Systems: A Guide to Present and Future Technologies