Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients

Abstract

Purpose: Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history.

Methods: We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up.

Results: Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement.

Conclusion: Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.

Keywords: Elbow; Elbow prosthesis complications; Elbow prosthesis survival; Fracture; Prosthesis.

Fig. 1

Sequence of radiographs from a clinical case of an elbow affected by primary osteoarthritis. (A) Preoperative x-rays; (B) Post-operative x-rays; (C) Follow-up x-rays one year after surgery

Fig. 2

Dehiscience of surgical wound and acute periprosthetic infection

Fig. 3

X-rays of a periprosthetic ulnar fracture and Coonrad Morrey stem fracture

Fig. 4

X-rays of aseptic loosening

Fig. 5

(A) X-ray of pin loosening after wearing of bushing’s polyethylene component; (B) (C) (D) intraoperative images of pin loosening after asymmetrical wearing of bushing’s polyethylene component

Graphic 1

(A) Distributions compared in Interval A from October 2002 to September 2009 (on the left; substantial uniformity between the main applications of the prosthesis) and in Interval B from October 2009 to September 2016 (on the right; clear superiority of the TR group). (B) With each passing year there is an increase in the trend (expressed by the dotted lines) of the implantation of CM elbow prosthesis on fractures of the distal humerus

Graphic 2

Kaplan-Meier survival function of CM implants: survival time of 90% at 60 months (5years), 85% at 120 months (10 years) and 83% at 180 months (15 years); the 95% confidence interval is indicated in light blue. Diversified survival function for the different indications that led to the prosthetic implant at 60 months (5 years) the survival rate was 97% for FX, 91% for INS and ANK, 82% for RA and 79% for OA while at 120 months (10 years) was 97% for FX, 91% for ANK, 84% for INS, 73% for RA and 70% for OA