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Semiconstrained Primary and Revision Total Elbow Arthroplasty with Use of the Coonrad-Morrey Prosthesis
Lewis L. Shi, MD1; David Zurakowski, PhD2; Deryk G. Jones, MD3; Mark J. Koris, MD1; Thomas S. Thornhill, MD1
1 Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for T.S. Thornhill: tthornhill@partners.org
2 Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
3 Department of Orthopaedic Surgery, Tulane University Health Sciences Center, 1430 Tulane Avenue, S132, New Orleans, LA 70112
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston; Children's Hospital Boston, Boston, Massachusetts, and at the Department of Orthopaedic Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jul 01;89(7):1467-1475. doi: 10.2106/JBJS.F.00715
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Abstract

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 published reports.

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.

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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