Background: Semiconstrained total elbow prostheses are used
routinely by many surgeons to treat a variety of severe elbow disorders. Our
objective was to review the results of primary and revision total elbow
arthroplasty with use of the Coonrad-Morrey prosthesis. The selected use of
this semiconstrained implant in patients with instability and poor bone stock
was hypothesized to provide inferior results compared with those in the
Methods: The results of sixty-seven semiconstrained total elbow
arthroplasties that were performed in fifty-six patients between 1990 and 2003
were evaluated. Thirty-seven elbows had a primary arthroplasty and were
followed for a mean of eighty-six months, and thirty elbows had a revision
arthroplasty and were followed for a mean of sixty-eight months. Mayo elbow
performance scores and radiographic analyses were used to assess the clinical
Results: In the primary arthroplasty group, the average flexion
improved from 116° to 135°; average extension, from —40° to
—33°; average pronation, from 60° to 81°; and average
supination, from 60° to 69°. The improvements in flexion and pronation
were significant (p < 0.001 for both). Preoperatively, twenty-five (74%) of
thirty-four elbows with data available had moderate or severe pain, whereas
only four (11%) had pain postoperatively. The average postoperative Mayo score
(and standard deviation) was 84 ± 16. Eleven of the thirty-seven
primary replacements failed, and the five-year survival rate was 72%. In the
revision arthroplasty group, average flexion improved from 124° to
131°; average extension, from —32° to —22°; average
pronation, from 66° to 75°; and average supination, from 64° to
76°; the improvement in supination was significant (p < 0.05).
Preoperatively, eighteen (64%) of the twenty-eight elbows with data available
had moderate or severe pain, while only five (17%) had pain postoperatively.
The average postoperative Mayo score was 85 ± 16. Eleven of the thirty
revision replacements failed, and the five-year survival rate was 64%.
Conclusions: A Coonrad-Morrey semiconstrained total elbow
arthroplasty provides excellent pain relief and good functional return in
patients with severe destructive arthropathy. The higher prevalence of failure
in this cohort compared with series reported elsewhere is likely due to
adverse patient selection as this implant was reserved for more complex
arthroplasties with severe bone loss and ligamentous laxity.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.