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Published on: January 24, 2018
Failure patterns after linked semiconstrained total elbow arthroplasty for posttraumatic arthritis
Thomas Throckmorton1, Peter Zarkadas, Joaquin Sanchez-Sotelo
1Department of Orthopedics, Mayo Clinic, Rochester, MN 55906, USA.
Summary
Total elbow arthroplasty for posttraumatic arthritis has a high failure rate, especially in patients under 60. Understanding failure modes like infection and wear can improve implant design and surgical techniques.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Reconstructive Surgery
Background:
- Posttraumatic arthritis often necessitates total elbow arthroplasty.
- Semiconstrained total elbow arthroplasty (TEA) demonstrates a notable failure rate in treating posttraumatic arthritis.
- Identifying failure mechanisms is crucial for enhancing implant design and surgical procedures.
Purpose of the Study:
- To analyze the failure modes and long-term outcomes of semiconstrained total elbow arthroplasty in patients with posttraumatic arthritis.
- To identify patient demographics and failure patterns associated with revision or resection.
Main Methods:
- Eighty-five semiconstrained total elbow arthroplasties were performed on 84 patients for posttraumatic arthritis.
- Sixty-nine primary prostheses were followed for an average of 9 years, with clinical outcomes assessed using the Mayo Elbow Performance Score.
- Radiographs were evaluated for mechanical failure, and all complications were meticulously recorded.
Main Results:
- A 19% failure rate (16 of 85 primary arthroplasties) was observed, with causes including bushing wear (7), infection (4), component fracture (3), and loosening (2).
- Early failures (<5 years) were primarily due to infection, while intermediate-term failures (5-10 years) were linked to bushing wear.
- Seventy-five percent of failures occurred in patients under 60 years old. Despite failures, significant improvements in pain, motion, and Mayo Elbow Performance Scores were noted, with a 15-year survival rate of 70%.
Conclusions:
- Semiconstrained TEA for posttraumatic arthritis imposes significant demands, leading to a high failure rate, particularly in patients under 60.
- Infection is a common cause of early failure, whereas bushing wear and component fracture/loosening dominate intermediate and late-term failures.
- While aseptic loosening is less common, understanding these failure modes is critical for improving long-term implant survival and patient satisfaction.
