R.M. Urban, S.H. Goldberg, J.J. Jacobs, G.J.W. King, S.W. O'Driscoll, and M.S. Cohen reply:

We agree with Dr. Morrey that cause and effect are difficult to establish in a retrospective, observational study of a subset of retrieved total elbow arthroplasty prostheses. A multicenter study involving the patients of several elbow arthroplasty surgeons was needed to generate a sufficient number of implants to allow us to make observations regarding modes of wear in total elbow arthroplasty. Rather than determining cause and effect, the primary purpose of the study was to demonstrate that osteolysis and aseptic loosening occur in patients with total elbow replacement, that these processes are similar to what has been more extensively described with total …


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