TY  - JOUR
T1  - Modes of Wear After Semiconstrained Total Elbow Arthroplasty
AU  - Morrey, Bernard F.
Y1  - 2009/02/01
N1  - 
JO  - The Journal of Bone & Joint Surgery
SP  - 487
EP  - 488
VL  - 91
IS  - 2
N2  - 
Table E-2 lists an array of problems, including four implant fractures, that make it extremely difficult to determine cause and effect. Did bushing wear cause lysis that allowed the fracture or did the fracture produce metallic particles that accelerated bushing wear? Furthermore, twelve of fourteen patients in their series had a precoat ulnar surface preparation. It is well described in the orthopaedic literature that a precoat surface renders a cemented implant vulnerable to osteolysis and failure1. The most notable feature of a loose precoat cemented surface is the rapid and aggressive osteolysis around the stem, which is due to an extensive release of debris particles2. The radiographic appearance of the patient described in Figure 2-B of the article is classic for this type of debonding failure and subsequent osteolysis. This phenomenon clearly plays a role in generating debris that finds its way into the joint, causing third-body wear. The analysis emphasized the specific design of this articulation and the manner in which it is vulnerable to edge-loading. However, nine of the patients had failure consistent with third-body wear as a cause or effect of the failure (Table E-2). My specific point is that we have no data that allow us to conclude that a worn bushing alone leads to sufficient osteolysis to cause stem loosening. This is important since, in our experience with almost 1000 replacements, we have not yet once been able to document a loose stem due solely to osteolysis related specifically to bushing wear3.

SN  - 0021-9355
M3  - doi: 
UR  - http://dx.doi.org/
ER  -