Abstract
In the past decade, the applications of elbow arthroplasty have been expanded to the treatment of degenerative and post-traumatic conditions. The most common complications include aseptic loosening, infection, periprosthetic fracture and triceps insufficiency, implant instability, and ulnar neuropathy. The incidence of clinically significant aseptic loosening is 7–15%, but the rate of periprosthetic radiolucency without clinical symptoms is even higher. Aseptic loosening is the most frequent cause of long-term implant failure. Although component loosening may be related to several causes, the most common risk factors include mechanical failure, inadequate surgical technique, and patient non-compliance. The indication for surgical revision is based on the assessment of elbow function, pain-limited activities of daily living, and pain at rest. The physical examination includes the signs that suggest infection. Radiographic evaluation assists in staging and depicts the main features of implant loosening. Plain anteroposterior and lateral radiographs are usually obtained, and computed tomography may be useful to gauge the extent of stem loosening and bone loss. Surgical revision is usually indicated in patients with polyethylene wear or symptomatic loosening of linked semiconstrained prostheses. It should also be considered in patients with progressive radiolucency or extensive osteolysis even in the absence of symptoms. Preoperative planning requires imaging data to gauge bone stock status and quality, osteolysis, component loosening, and implant status. The most common indications for reoperation following aseptic loosening are bushing replacement and reimplantation with or without bone augmentation.
In conclusion, aseptic loosening of total elbow arthroplasty may result from several causes, and revisions are technically demanding procedures.
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References
Little CP, Graham AJ, Carr AJ. A systematic review of the literature in the English language until the end of the 2003. J Bone Joint Surg (Br). 2005;87:437–44.
Alolridge JM III, Lightdale NR, Mallan WJ, Coonrad RW. Total elbow arthroplasty with the Coonrad/Coonrad-Morrey prosthesis a 10 to 31 year survival analysis. J Bone Joint Surg (Br). 2006;88B:509–14.
Morrey BF. Results by design: linked versus unlinked implants. In: Morrey BF, An KN, Sperling JW, editors. Joint replacement arthroplasty: basic science, elbow and shoulder. Philadelphia, PA: Lippincott Williams and Wilkins; 2011. p. 92–7. Chapter 10.
Voloshin I, Morrey BF. Complications of total elbow arthroplasty. In: Morrey BF, An KN, Sperling JW, editors. Joint replacement arthroplasty: basic science, elbow and shoulder. Philadelphia: Lippincott Williams and Wilkins; 2011. p. 150–66. Chapter 17.
Schneeberger AG, Meyer DL, Yan EH. Coonrad-Morrey total elbow replacement for primary and revision surgery: a 2 to 7,5 year fall-up study. J Shoulder Elb Surg. 2007;16:547–54.
Schuind F, O’Driscoll S, Korine KS, An KN, Morrey BF. Loose-hinge total elbow arthroplasty: an experimental study of the effect of implant alignment on three-dimensional elbow kinematic. J Arthroplast. 1995;10:670–8.
Cheung EV, O’Driscoll SW. Total elbow prosthesis loosening caused by ulnar component pistoning. J Bone Joint Surg Am. 2007;89:1269–74.
Morrey BF, Bryan RS. Revision total elbow arthroplasty. J Bone Joint Surg Am. 1987;69(4):523–32.
Deut CM, Hoy G, Stanley JK. Revision of failed total elbow arthroplasty. J Bone Joint Surg (Br). 1995;77(5):691–5.
Shi LL, Zurokowski Jones DG, Koris MJ, Thornhill TS. Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Joint Surg Am. 2007;89:1467–75.
Celli A, Morrey BF. Total elbow arthroplasty in patients forty years of age or less. J Bone Joint Surg Am. 2009;91(6):1414–8.
Morrey BF. Linked elbow arthroplasty rational, design concept and surgical technique. In: Morrey BF, Sanchez Sotelo J, Morrey M, editors. Morrey’s the elbow and its disorders. 5th ed. Amsterdam: Elsevier; 2018. p. 855–68.
Barlow JD, Morrey BF, O’Driscoll SW. Activities after total elbow arthroplasty. J Shoulder Elb Surg. 2013;22:797.
Lee BP, Adams RA, Morrey BF. Polyethylene wear after total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:1080–7.
Chon RKW, King GJW. The management of the failed total elbow arthroplasty. In: Stanley D, Trail I, editors. Operative elbow surgery. Edinburgh: Elsevier; 2012. p. 665–94.
Mansat P, Adams RA, Morrey BF. Allograft prosthesis composite for revision of catastrophic failure of total elbow arthroplasty. J Bone Joint Surg Am. 2004;86:724–35.
Celli A, Bonucci P. The Anconeus-triceps lateral flap approach for total elbow arthroplasty in rheumatoid arthritis. Musculoskelet Surg. 2016;100(Suppl 1):73–83.
Celli A. A new posterior triceps approach for total elbow arthroplasty in patients with osteoarthritis secondary to fracture: preliminary clinical experience. J Shoulder Elb Surg. 2016;25(8):e223–31.
King GJW. Reoperative conditions following total elbow arthroplasty. In: Ducan S, editor. Reoperative hand surgery: Springer Science Business Media; 2012. p. 199–225.
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Andrea, C., Guglielmo, D.L., Luigi, C. (2020). Failure of Semiconstrained Elbow Arthroplasty: Aseptic Loosening and Revision. In: Castoldi, F., Giannicola, G., Rotini, R. (eds) Elbow Arthroplasty . Springer, Cham. https://doi.org/10.1007/978-3-030-14455-5_14
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