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Studies find infection, excess load among total elbow implant failure mechanisms

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LAS VEGAS — Using a semiconstrained elbow replacement in patients with post-traumatic osteoarthritis produced failures of the device and other complications, some at long-term follow-up, according to two studies presented here at the American Academy of Orthopaedic Surgeons 76th Annual Meeting.

Both presenters noted, however, that the Coonrad-Morrey prosthesis (Zimmer) they studied was originally indicated for patients with rheumatoid arthritis, and in that population, it has historically performed well.

Thomas Throckmorton, MD, presented a long-term study that indicated infection was the greatest cause of early failure. Bushing wear and stem loosening were mostly responsible for mid- and long-term failures in the series, he said.

Throckmorton and co-investigators followed 85 consecutive patients who received the Coonrad-Morrey elbow implants between 1987 and 2004. The Kaplan-Meier survivorship analysis showed a 70% survivorship rate at 15 years postsurgery for resection or revision of any kind.

In a second presentation, William H. Seitz Jr., MD, offered results of a retrospective review of failures among cases two surgeons at his institution completed between 1999 and 2007. He said the “very young” age of the patients in the series (45 years, mean) could have led to an overloading of the implant. Seitz also suggested that the new snap-fit central pin assembly added in the late 1990s could have contributed to the failures.

“As we apply these to younger individuals who are going to be placing greater force on them, we need to be careful,” he said. Consequently, regular follow-up is important.

Bernard F. Morrey, MD, noted that he and other surgeons recently entertained ways to improve the implant’s design. “We are considering some potential changes,” he said.

Seitz and Throckmorton have no financial conflicts to disclose related to products or companies mentioned in this article.

References:

• Seitz WH, Evans PJ, Bismar HA. Mechanical failure of the Coonrad-Morrey total elbow prosthesis due to excessive loading. Paper #59.
• Throckmorton T, Zarkadas PC, Sanchez-Sotelo J, Morrey BF. Failure mechanisms of semiconstrained total elbow arthroplasty for post-traumatic arthritis. Paper #60. Both presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.