Failure Patterns After Linked Semiconstrained Total Elbow Arthroplasty for Posttraumatic Arthritis

Throckmorton, Thomas W.; Zarkadas, Peter C.; Sánchez-Sotelo, Joaquín; Morrey, B.F.

doi:10.2106/jbjs.i.00145

Cited by 111 publications

(69 citation statements)

References 15 publications

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“…It is possible that more recent patients with RA are more active than most of the patients included in this study 19 . Thus, the results of our study should be interpreted with caution, since more active patients with RA might be prone to a higher implant failure rate as seen in patients with posttraumatic arthritis 20 . It is also important to realize that over the last 2 decades, the indications for elbow arthroplasty have been expanded to patients without inflammatory arthritis.…”

Section: Discussionmentioning

confidence: 85%

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis

Sánchez-Sotelo

Baghdadi

Morrey

2016

The Journal of Bone and Joint Surgery

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Background: Elbow arthroplasty is the treatment of choice for end-stage rheumatoid arthritis (RA). The purpose of this study was to determine the long-term outcome of a linked semiconstrained elbow arthroplasty implant design in patients with RA. Methods: Between 1982 and 2006, 461 primary total elbow arthroplasties using the Coonrad-Morrey prosthesis were performed in 387 patients with RA. Fifty-five of the arthroplasties were performed to treat concurrent traumatic or posttraumatic conditions. There were 305 women (365 elbows, 79%) and 82 men (96 elbows, 21%). Ten patients (10 elbows) were lost to follow-up, 9 patients (10 elbows) died, and 6 patients (6 elbows) underwent revision surgery within the first 2 years. For the 435 elbows (362 patients, 94%) with a minimum of 2 years of follow-up, the median follow-up was 10 years (range, 2 to 30 years). Results: At the most recent follow-up, 49 (11%) of the elbows had undergone component revision or removal (deep infection, 10 elbows; and mechanical failure, 39 elbows). Eight additional elbows were considered to have radiographic evidence of loosening. For surviving implants followed for a minimum of 2 years, the median Mayo Elbow Performance Score (MEPS) was 90 points. Bushing wear was identified in 71 (23%) of the surviving elbows with a minimum of 2 years of radiographic follow-up; however, only 2% of the elbows had been revised for isolated bushing wear. The rate of survivorship free of implant revision or removal for any reason was 92% (95% confidence interval [CI] = 88% to 94%) at 10 years, 83% (95% CI = 77% to 88%) at 15 years, and 68% (95% CI = 56% to 78%) at 20 years. The survivorship at 20 years was 88% (95% CI = 83% to 92%) with revision due to aseptic loosening as the end point and 89% (95% CI = 77% to 95%) with isolated bushing exchange as the end point. Risk factors for implant revision for any cause included male sex, a history of concomitant traumatic pathology, and implantation of an ulnar component with a polymethylmethacrylate surface finish. Conclusions: Elbow arthroplasty using a cemented linked semiconstrained elbow arthroplasty provides satisfactory clinical results in the treatment of RA with a reasonable rate of survivorship free of mechanical failure at 20 years. Although bushing wear was identified on radiographs in approximately one-fourth of the patients, revision for isolated bushing wear was uncommon. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 85%

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis

Sánchez-Sotelo

Baghdadi

Morrey

2016

The Journal of Bone and Joint Surgery

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“…Cumulative revision rates after four to five years for fixed-hinge models is 13%, for sloppy hinge models 11%, and for unlinked models 13% [25] . In the short term, the main cause of failure is infection, while in the long term, the main cause is aseptic loosening by prosthetic wear [25,26] . When compared per group, the fixed-hinge models have a loosening rate of 11%, the sloppy hinged models 5% and the unlinked TEA's 10% [25] .…”

Section: The Presentmentioning

confidence: 99%

Total elbow arthroplasty is moving forward: Review on past, present and future

Prkić

Bergen

Eygendaal

2016

WJO

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The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps have been taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.

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“…The complications rate of elbow replacement after complex fractures ranged between 27% to 43% and the rate of postoperative complications ranged from 22% to 28% [8] [18] [19].…”

Section: Introductionmentioning

confidence: 99%

Total Elbow Replacement as an Alternative to Severely Comminuted Fractures around the Elbow

Ginesin¹,

Norman²

2017

OJO

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Background: Intra articular elbow fractures are considered to be one of the most complex injuries in orthopedic trauma. Some are too comminuted for open reduction and internal fixation. Recently total elbow replacement (TER) had gained popularity for the treatment of comminuted elbow trauma when other treatment options are not possible. Methods: Since 2007-2013 we treated 18 patients with TER due to comminuted distal humeral fractures. We used the Disabilities of the Arm, Shoulder and Hand scoring system (DASH) to evaluate the patient's satisfaction. In addition, we evaluated the elbow range of motion and collateral stability. Results and Conclusions: Functional range of motion was achieved with high patient's satisfaction. Based on the results, we conclude that TER is a reasonable option for complex elbow fractures when open reduction and internal fixation is not suitable.

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Failure Patterns After Linked Semiconstrained Total Elbow Arthroplasty for Posttraumatic Arthritis

Cited by 111 publications

References 15 publications

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis

Total elbow arthroplasty is moving forward: Review on past, present and future

Total Elbow Replacement as an Alternative to Severely Comminuted Fractures around the Elbow

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