Ulnar component surface finish influenced the outcome of primary Coonrad-Morrey total elbow arthroplasty

Jeon, In-Ho; Morrey, B.F.; Sánchez-Sotelo, Joaquín

doi:10.1016/j.jse.2011.08.062

Cited by 28 publications

(8 citation statements)

References 30 publications

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“…Alterations to fixation surfaces were made to enhance fixation. When the original sintered metallic bead-coated Coonrad-Morrey components were compared with an alternate design with cement precoating, survival at 7 years dropped from 93% to 83% [17]. The cause of the premature failures remains elusive, but like with precoated THAs, precoat debonding and the generation of a large burden of PMMA and metallic debris are likely factors.…”

Section: Where Are We Now?mentioning

confidence: 99%

What Design and Material Factors Impact the Wear and Corrosion Performance in Total Elbow Arthroplasties?

Figgie

Wright

Drinkwater

2014

Clin Orthop Relat Res

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The survivorship of total elbow arthroplasties is lower than surgeons and patients would like it to be, especially in patients with posttraumatic arthritis of the elbow. To improve durability, it is important to understand the failure modes of existing implants. Total elbow arthroplasties were designed primarily for low-demand rheumatoid patients. As surgical indications have extended to more active patient populations, the mechanical performance of current designs must meet an increased mechanical burden. Evaluating the degree to which they do this will guide conclusions about which contemporary devices might still meet the need and, as importantly, what design and material changes might be needed to improve performance. WHERE ARE WE NOW?: The reasons for failures of total elbow arthroplasties include infection, loosening, polyethylene wear, locking mechanism failure, periprosthetic fracture, implant fracture, and instability. Implant design factors that have influenced wear include implant constraint, material, coatings, and metal backing. Surgical factors associated with increased wear and subsequent total elbow arthroplasty failure include soft tissue balancing and restoration of alignment and implant positioning. WHERE DO WE NEED TO GO?: A clear need exists for improving the performance of total elbow arthroplasty. Many of the failures that have limited the survivorship of elbow arthroplasties thus far are mechanical in nature with wear-related problems a dominating influence. Much of what we know about the results of total elbow arthroplasty is from small studies frequently involving the designer of the implant. The establishment of total elbow arthroplasty registries coupled with the increasing regulatory burden of postmarket surveillance would lead to a better understanding of the complications and survivorship of elbow arthroplasties. Another primary goal must be to achieve a better understanding of the biomechanics of the normal elbow and how the mechanics are altered after the insertion of elbow arthroplasty components. HOW DO WE GET THERE?: Improving the performance and survivorship of total elbow arthroplasty will require the integration of clinical and implant performance data gained through the establishment of registries with a concerted basic science effort to better understand the functional loads across the joint and to incorporate these loads into experimental and computational models to allow assessment of design and material changes intended to improve durability.

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Section: Where Are We Now?mentioning

confidence: 99%

What Design and Material Factors Impact the Wear and Corrosion Performance in Total Elbow Arthroplasties?

Figgie

Wright

Drinkwater

2014

Clin Orthop Relat Res

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“…It was particularly high with the PMMA precoated ulnar component. A previous study has noted the high failure rate of this surface finish, in which component debonding from cement led to florid osteolysis and sometimes periprosthetic fracture 12 . This seems to have been resolved with the current plasma spray surface finish.…”

Section: Discussionmentioning

confidence: 92%

“…There were no custom humeral components; 9 procedures were performed using a custom ulnar component. The surface finish of the ulnar component of this implant system was modified over time 12 . Thirty-six ulnar components had an early (firstgeneration) plasma spray coating, 157 had a beaded porous coating, 140 were precoated with PMMA, and 128 had a modern plasma spray coating.…”

Section: Implants and Proceduresmentioning

confidence: 99%

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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“…The ulnar component was modified from a beaded surface to a polymethylmethacrylate-precoated surface in 1992, but it was turned back to have a beaded surface in 2001. [26][27][28] This design has been used to treat conditions including RA, degenerative arthritis, and trauma reconstruction, and satisfactory outcomes have been reported with longterm follow-up. 25,[29][30][31][32][33][34][35][36] However, aseptic loosening together with bushing wear is a leading complication of implant failure, and reducing the complication rate remains a challenge.…”

Section: Linked Semiconstrained Design (Coonrad-morrey)mentioning

confidence: 99%

Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery

2019

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Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients. Total elbow prostheses have evolved over the years and now include the linked, unlinked, and convertible types. However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Here, we introduce each type of implant and evaluate clinical outcomes and complications by reviewing the previous literature.

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Ulnar component surface finish influenced the outcome of primary Coonrad-Morrey total elbow arthroplasty

Cited by 28 publications

References 30 publications

What Design and Material Factors Impact the Wear and Corrosion Performance in Total Elbow Arthroplasties?

What Design and Material Factors Impact the Wear and Corrosion Performance in Total Elbow Arthroplasties?

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis

Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery

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