Outcome of Semi-Constrained Total Elbow Arthroplasty in Posttraumatic Conditions with Analysis of Bushing Wear on Stress Radiographs

Abstract

Background: Total elbow arthroplasty for posttraumatic arthritis or nonunion has been associated with a high rate of complications. Bushing wear is a known complication, although the actual incidence is unknown because stress views of the elbow are not routinely performed. We evaluate incidence of bushing wear in total elbow arthroplasty using stress radiographs.

Methods: Eighteen patients underwent total elbow arthroplasty from 1997-2009 for posttraumatic arthritis or distal humerus nonunion using the third generation Coonrad-Moorey design. Eight patients met inclusion criteria and had an average age of 67 years and mean follow-up of 105 months. Radiographs were analyzed for bushing wear and implant loosening on standard and stress radiographs. Clinical outcome measures included the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, Mayo Elbow Performance Score (MEPS), overall patient satisfaction, range of motion, and complications.

Results: Rate of bushing wear was high, and stress views were five times more sensitive in detecting bushing wear (63%) compared to non-stress views (12%). Seventy-five percent of patients had a good or excellent MEPS. Range of motion slightly improved from pre- to post-operatively. Minor complications were common, but there were no revisions and no cases with radiographic loosening. There was no correlation between bushing wear and the DASH or MEPS.

Conclusion: Incidence of bushing wear in total elbow arthroplasty is high, and under-diagnosed without stress views. Although minor complications are common, frequent loosening and revision do not occur as previously reported for other implants. Despite bushing wear, mid-term functional outcomes are good.

Level of evidence: Therapeutic IV.

Figure 1. A 59-year-old female with distal humerus nonunion and hardware failure underwent total elbow arthroplasty. There was significant bushing wear and stable type I osteolysis at 14.4 years, a) pre-operative AP, b) AP, c) lateral, d) valgus stress, e) varus stress at 14.4 years.

Figure 2. A 66-year-old female with distal humerus nonunion underwent total elbow arthroplasty. Postoperative radiographs show moderate bushing wear and Type I osteolysis at 10.6 years, a) preoperative AP; b) post-operative AP, c) valgus stress, d) and lateral view at 10.6 years.