Background: Fractures of total elbow arthroplasty components are
uncommon, and the literature provides little guidance regarding the management
and outcomes of treatment of these complications. The goal of this report was
to investigate the prevalence and management of fractures of ulnar and humeral
components following total elbow arthroplasty and to review our experience
with cement-within-cement reconstruction for revision following such
Methods: Between 1979 and 2003, twenty-four patients with a total of
twenty-seven fractured total elbow arthroplasty components (seventeen ulnar
and ten humeral) of different designs presented to our institution. Twenty-six
implants underwent subsequent revision elbow arthroplasty at our institution.
Fourteen of those revisions were done with a cement-within-cement technique,
and twelve, with traditional methods. Twenty-one patients (twenty-three
implants) were available for final follow-up, and data that had been acquired
prospectively and entered into the institutional arthroplasty database were
reviewed retrospectively. At the time of final follow-up, the Mayo Elbow
Performance Score (MEPS) was calculated and preoperative, postoperative, and
most recent radiographs were examined for bone loss, bushing wear, and
integrity of the bone-cement interface.
Results: The prevalences of humeral and ulnar component fracture
following primary total elbow arthroplasties performed at our institution were
0.65% and 1.2%, respectively. At a mean of 5.1 years following revisions for
those fractures, the MEPS was excellent for eight patients, good for five,
fair for six, and poor for two. The average MEPS was 82 points following the
revision total elbow arthroplasties done with the cement-within-cement
technique and 78 points following the revisions done with the traditional
method of cement removal and insertion of a revision component. Complications
included seven intraoperative cortical perforations; five nerve injuries, two
of which were permanent; three triceps avulsions; and one deep infection.
Conclusions: Implant fractures following total elbow arthroplasty
are uncommon. They occur for several reasons, such as notch sensitivity,
component design, and high stresses due to bone deficiency. Revision
techniques, such as cement-within-cement reimplantation, are reliable for
relieving pain and restoring function; however, the rate and spectrum of
complications are a cause for concern.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.