Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea

Jung-Man Kim; Sang-Myung Lee; Jae-Chul Park; Seok-Whan Song; Yang-Guk Jung; Ki-Hyun Boo; Seung-Koo Rhee

doi:10.4055/jkoa.2010.45.1.10

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Kim, Lee, Park, Song, Jung, Boo, and Rhee: Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(1): 10-15.

Published online: 28 February 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.1.10

Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea

Jung-Man Kim, M.D., Sang-Myung Lee, M.D.^*, Jae-Chul Park, M.D.^*, Seok-Whan Song, M.D.^*, Yang-Guk Jung, M.D., Ki-Hyun Boo, M.D.^*, Seung-Koo Rhee, M.D.^*

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Correspondence to: Seung-Koo Rhee, M.D. Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine, 60, Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. TEL: +82-2-3779-1192, FAX: +82-2-783-0252, skrhee@catholic.ac.kr

Received 24 July 2009 Accepted 25 November 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Few studies have compared the outcomes, complications and revision rate of a total elbow replacement (TER) prosthetic design. This study examined a series of patients with semiconstrained and unconstrained total elbow replacements (TER) and evaluated them for any functional differences, complications and revision rates that might be attributable to the prosthetic design.

Materials and Methods

A total 78 cases of primary TER was performed in 71 patients. Their mean age at TER was 54 years. The causes of TER were rheumatoid arthritis in 42, post-traumatic arthritis and osteoarthritis 24 and 5 patients, respectively. Unconstrained and semiconstrained TER was employed in 35 and 43 cases, respectively. The end results of TER by the Mayo elbow performance score (MEPS), their elbow range of motion before and after surgery, their complications and revision rates after an average 13 year follow-up were evaluated.

Results

The MEPS was improved from 33 points pre-operatively to 87 points post-operatively (p<0.001). Active flexion-extension elbow motions were also improved markedly from 27°-86° pre-operatively to 16°-128° postoperatively (p<0.001). There was no significant difference between the semiconstrained and unconstrained TER in the post-operative MEPS (p=0.764) and range of motion (p=0.728). The complication rate was much higher in the unconstrained groups than in the semiconstrained group (p=0.014). The mean total revision rate was 29.5%. There was no significant difference in revision rate between the unconstrained and semiconstrained groups (p=0.402). Loosening was found in a total of 12 cases (15.4%). There was also no significant difference in loosening between the semiconstrained and unconstrained groups (p=0.382).

Conclusion

Favorable results of MEPS and elbow motion were obtained in both the unconstrained and semiconstrained types after an average 13 year follow up after TER. However, the semiconstrained type of TER showed a lower complication rate than the unconstrained type of TER.

Keywords: total elbow replacement, revision rate, complication, unconstrained type, semiconstrained type

Figures and Tables

Figure 1

A 74-year-old rheumatoid arthritis woman presented with left dominant elbow pain worsening over the past 3 years without injury. Past history identifies that she was operated total elbow replacement arthroplasty 16 years ago. (A) Pre-operative X-ray and Intra-op findings (2004. 7) for Pritchard ERS, resurfacing type. (B) Post-operative X-ray: After changing to Coonrad-Morrey type (2005. 10) showing good cement fixation but ectopic ossification.

Figure 2

A 53-year-old, rheumatoid arthritis woman presents a closed periprosthetic fracture after a fall while walking street. she was operated total elbow replacement arthroplasty 10 years ago. (A) Pre-operative X-ray showing periprosthetic failure of distal humerus and cement loosening of 10 years follow up for Kudo total elbow replacement. (B) Post-operative X-ray: One year after revision to Coonrad-Morrey type with wiring for fracture.

Table 1

Materials and Types of Total Elbow Replacement

^*PM, Pritchard Mark; ERS, Elbow Resurfacing System.

Table 2

Pre- and Post-operative Mayo Elbow Performance Score (MEPS)

Table 3

Complications of TER

Comparison was used by Pearson Chi-squire-test.

Table 4

End Result of TER

^*MEPS, Mayo Elbow Performance Score; Comparison was used by Student t-test.

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