Background: Articular wear is considered to be a possible long-term
complication of the use of stemmed, coupled elbow replacements with the
capacity to correct deformity and restore function. There have been no reports
on this topic, to our knowledge.
Methods: A review of the results of 919 replacements with the
semiconstrained linked Coonrad-Morrey total elbow implant, performed between
1981 and 2000, revealed that twelve patients (1.3%) had undergone an isolated
exchange of the articular bushings as a result of polyethylene wear. The
status of these patients was assessed clinically and radiographically.
Results: The mean age of the twelve patients at the time of the
initial total elbow replacement was forty-four years compared with a mean age
of sixty-two years in the overall group (p < 0.001). Seven of the twelve
patients had posttraumatic arthritis, and five had rheumatoid arthritis. Nine
patients had extensive deformity. The group consisted of seven women and five
men, and ten patients had involvement of the right dominant elbow. The mean
age at the bushing revision was fifty-two years, and the bushings were revised
at an average of 7.9 years after implantation. All twelve patients reported
pain, and five reported crepitus or a squeaking sound. None had extensive
osteolysis. The mean duration of follow-up after the bushing exchange was
sixty-five months. The mean arc of motion improved from 89° before the
surgery to 109° after it. Three of the twelve patients underwent an
additional articular revision at fifty-three, fifty-four, and 136 months after
the initial bushing exchange. At the time of final follow-up, all twelve
patients had functioning elbows.
Conclusions: Isolated bushing exchange can be a successful revision
procedure in patients with a semiconstrained linked total elbow prosthesis.
Younger patients with a posttraumatic condition and/or severe pre-existing
deformity are at greater risk for the development of excessive bushing wear.
Patients should be cautioned against exceeding the recommended activity and
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.