The Journal of Bone and Joint Surgery 82:1379 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Functional Outcome of Semiconstrained Total Elbow Arthroplasty*
Kevin A. Hildebrand, M.D., F.R.C.S.(C) ,
Stuart D. Patterson, M.B., Ch.B., F.R.C.S.(C) ,
William D. Regan, M.D., F.R.C.S.(C) ,
Joy C. MacDermid, B.Sc., P.T., M.Sc., Ph.D.# and
Graham J.W. King, M.D., M.Sc., F.R.C.S.(C)#
Investigation performed at the Hand and Upper Limb Centre,
St. Joseph's Health Centre, University of Western Ontario, London,
Ontario, Canada
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Department of Surgery, University of Calgary, 3330 Hospital Drive,
N.W., Calgary, Alberta T2N 4N1, Canada.
Bond Clinic, 500 East Central Avenue, Winter Haven, Florida 33880.
§Department of Orthopaedic Surgery, Allan McGavin Sports Medicine
Centre, The University of British Columbia, 3055 Westbrook Mall,
Vancouver, British Columbia V6T 1Z3, Canada.
#Department of Surgery, University of Western Ontario, St. Joseph's
Health Centre, Hand and Upper Limb Centre, 268 Grosvenor Street,
London, Ontario N6A 4L6, Canada.
Background: The objective of the present
study was to review the results of primary total elbow arthroplasty
with use of the Coonrad-Morrey prosthesis. Two hypotheses were tested:
(1) the results in patients with inflammatory arthritis would be
superior to those in patients with a traumatic or posttraumatic condition,
and (2) the isometric extensor torque after total elbow arthroplasty
would be significantly less than that of the contralateral elbow.
Methods: Forty-seven consecutive patients (fifty-one
elbows) had the operation performed by one of three surgeons between
November 1, 1989, and June 30, 1996. Thirty-six surviving patients
(thirty-nine elbows) were available for follow-up. The mean duration
(and standard deviation) of follow-up was 50 ± 11
months (range, twenty-four to ninety-seven months). The mean age
at the time of the operation was 64 ± 11
years (range, twenty-seven to eighty-seven years). Eighteen patients
(twenty-one elbows) had inflammatory arthritis. Eighteen patients
(eighteen elbows) had an acute fracture or posttraumatic condition
(posttraumatic osteoarthritis in eight, an acute fracture of the
humerus in seven, nonunion of the distal aspect of the humerus in
two, and primary osteoarthritis in one). The patients were evaluated
with use of questionnaires (the Mayo elbow performance index, the
Short Form-36 [SF-36], and the Disabilities of the Arm, Shoulder
and Hand [DASH] Questionnaire); clinical examination by an orthopaedic
surgeon who was not involved with the preoperative, operative, postoperative,
or follow-up care; radiographs; and elbow strength-testing with
an isokinetic dynamometer.
Results: The mean score (and standard deviation)
on the Mayo elbow performance index for the group that had inflammatory
arthritis (90 ± 11 points) was significantly
higher than that for the group with a traumatic or posttraumatic
condition (78 ± 18 points) at the time of
the latest follow-up (p < 0.05). In both groups, the mean extensor
torque of the involved elbow was significantly less than that of
the contralateral elbow (p < 0.05). No significant difference
between the groups was found with respect to the flexion-extension
arc of motion. Ten elbows (26 percent) had ulnar nerve dysfunction
(a transient deficit in six and a permanent deficit in four); nine
(23 percent), an intraoperative fracture (of the humeral diaphysis
in four, of the ulnar diaphysis in four, and of the olecranon in
one); three (8 percent), a periprosthetic infection; three, a triceps
disruption; and one (3 percent), a revision because of a fracture
of the ulnar component. There were no other revisions. Of the thirty-four
elbows with complete radiographic follow-up, twenty-three had no
change in the bone-cement interface. Progressive radiolucency was
noted around the ulnar prosthesis in eight elbows, around the humeral prosthesis
in one elbow, and around both components in two elbows.
Conclusions: Patients who had a total elbow
arthroplasty with use of a semiconstrained Coonrad-Morrey prosthesis
were generally satisfied; the mean level of patient satisfaction
was 9.2 of a possible 10 points for those who had inflammatory arthritis
and 8.6 points for those who had a fracture or posttraumatic condition.
The rates of complications involving the ulnar nerve, intraoperative
fracture, triceps disruption, deep infection, and periprosthetic
radiolucency are of concern.
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