Total Elbow Replacement with Bakshi's Sloppy Hinge Prosthesis in UnsalvageableElbows: A Retrospective Study of Functional Outcomes

Abstract

Background: Distal humerus intra-articular fractures in elderly patients often lead to poor outcomes due to osteoporosis and complex joint mechanics. Total elbow arthroplasty (TEA) with constrained implants like Bakshi's sloppy hinge prosthesis offers a viable salvage option. This study evaluates the functional outcomes and complications of TEAin unsalvageable elbows. Methods: A retrospective analysis of 10 patients (2019–2022) undergoing primary or secondary TEA was conducted with a follow-up period of 3 years. Data included demographics, surgical details, range of motion, stability, and Mayo Elbow Performance Score (MEPS). Results: The cohort comprised 60% females, with a mean age of 63.6 years. Secondary TEA (70%) was more common than primary (30%). Non-union
(40%) and infection (30%) were leading causes for surgery. Postoperatively, 100% achieved stable elbows, 90% reported no pain, and 80% scored 'excellent' result on MEPS. Stability and arc of motion >100° (p=0.04) significantly correlated with better MEPS. Conclusion: TEA with Bakshi's prosthesis effectively restores function in complex elbow injuries, particularly in elderly patients with comorbidities. Outcomes of secondary TEA outperformed compared to primary procedures, emphasizing its role in salvaging failed prior interventions.