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Polyethylene wear after total elbow arthroplasty
Brian P Lee1, Robert A Adams, Bernard F Morrey
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Summary
Articular bushing wear in total elbow replacements can necessitate revision surgery. Isolated bushing exchange offers a successful solution, particularly for younger patients with severe deformity, but activity restrictions are advised.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Articular wear is a potential long-term complication of stemmed, coupled elbow replacements.
- No prior reports have detailed this specific complication and its management.
Purpose of the Study:
- To investigate the outcomes of isolated articular bushing exchange in patients with Coonrad-Morrey total elbow prostheses.
- To identify risk factors associated with excessive polyethylene wear in these implants.
Main Methods:
- Retrospective review of 919 Coonrad-Morrey total elbow replacements.
- Analysis of 12 patients (1.3%) who underwent isolated articular bushing exchange due to polyethylene wear.
- Clinical and radiographic assessment of these patients.
Main Results:
- Younger patients (mean age 44) with posttraumatic or rheumatoid arthritis and deformity were more likely to experience wear.
- Bushing revision (mean age 52, 7.9 years post-implantation) improved range of motion (89° to 109°).
- All 12 patients had functioning elbows at final follow-up (mean 65 months post-revision), with 3 requiring further revision.
Conclusions:
- Isolated bushing exchange is a successful revision strategy for polyethylene wear in linked total elbow prostheses.
- Younger patients with significant pre-existing deformity are at higher risk for bushing wear.
- Adherence to activity and lifting restrictions is crucial for implant longevity.