The Journal of Bone and Joint Surgery (American). 2005;87:1080-1087.
doi:10.2106/JBJS.D.02163
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Shoulder/Elbow Test 10: Summer 2005
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Polyethylene Wear After Total Elbow Arthroplasty

Brian P. Lee, MD1, Robert A. Adams, RPA2 and Bernard F. Morrey, MD2

1 Orthopaedic Associates, #16-03/04 Mount Elizabeth Medical Centre, Mount Elizabeth, 228510 Singapore
2 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. B.F. Morrey received royalties with the Coonrad-Morrey total elbow arthroplasty. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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 lifting restrictions.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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