Article
Radiological analysis to determine risk factors for aseptic loosening in the linked-type total elbow arthroplasty
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Published: | February 6, 2020 |
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Objectives/Interrogation: Total elbow arthroplasty yields good long-term results but requires revision surgery in some cases. We have recently experienced a first case of aseptic loosening of a linked-type total elbow performed at our institute which needed revision. We have analysed radiological features which may predict aseptic loosening in the linked-type total elbow arthroplasty.
Methods: 27 elbows with the Coonrad-Morrey prosthesis who were operated at our institute and followed up for more than three years, were included. 21 were female and 6 were male, and the mean age at the time of operation was 68. Every operation was performed by a single senior surgeon by Campbell's approach. Pre-operative x-rays and post-operative x-rays were analysed, including flexion-extension placement of both components, valgus-varus placement of both components, state of bone union at the anterior flange, state of cementing, and zone of osteolysis according to Hastings and degree of osteolysis according to Morrey.
Results and Conclusions: Type V osteolysis according to Morrey's classification (gross loosening) was seen in two cases (one on the humeral side, another on the ulnar side), type IV in two cases (one on the humeral side, another on both sides), and type I-III in four cases (three on the humeral side, one on both sides). One of the cases with type V osteolysis needed revision surgery of the humeral component 7 years and 10 months after the primary operation. Osteolysis types VI-V were significantly cubitus varus post-operatively compared to types I-III (carrying angle: type IV-V 180.4°(±5.4); type I-III 172.0°(±7.7). p<0.05). Mean extension angle placement of the humeral components and mean flexion angle placement of the ulnar components were also significantly higher in types IV-V. Cases of gross loosening presented with osteolysis beginning around the joint and spreading to the components. Post-operative cubitus varus may be a factor to predict future aseptic loosening hence precise component placement at the primary operation is essential to avoid it.