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B F Morrey - One of the best experts on this subject based on the ideXlab platform.
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Distal humeral fractures treated with noncustom Total Elbow Replacement. Surgical technique.
The Journal of bone and joint surgery. American volume, 2020Co-Authors: S Kamineni, B F MorreyAbstract:The purpose of this study was to review the cases of patients with a distal humeral fracture that was treated with a noncustom Total Elbow arthroplasty. We hypothesized that, on the basis of the functional and clinical outcome, Total Elbow Replacement is a reliable option for the treatment of elderly patients with a severe, comminuted fracture of the distal part of the humerus. We retrospectively reviewed forty-nine acute distal humeral fractures in forty-eight patients who were treated with Total Elbow arthroplasty as the primary option. The average age of the patients was sixty-seven years. Forty-three fractures were followed for at least two years. According to the AO classification, five fractures were type A, five were type B, and thirty-three were type C. The average age of the forty-three patients was sixty-nine years and the average duration of follow-up was seven years. Fourteen patients died during the review period. Postoperative clinical function was assessed with use of the Mayo Elbow performance score, and anteroposterior and lateral radiographs made at follow-up examinations were reviewed. At the latest follow-up examination, the average flexion arc was 24 degrees (range, 0 degrees to 75 degrees ) to 131 degrees (range, 100 degrees to 150 degrees ) and the Mayo Elbow performance score averaged 93 of a possible 100 points. Heterotopic ossification was present to some extent in seven Elbows, with radiographic abutment noted in two. Thirty-two (65%) of the forty-nine Elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Fourteen Elbows (29%) had a single complication, and most of them did not require further surgery. Ten additional procedures, including five revision arthroplasties, were required in nine Elbows; five were related to soft tissue and five were related to the implant or bone. Complex distal humeral fractures should be assessed primarily for the reliability with which they can be reconstructed with osteosynthesis. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, Total Elbow arthroplasty can be considered. This retrospective review supports a recommendation for Total Elbow arthroplasty for the treatment of an acute distal humeral fracture when strict inclusion criteria are observed.
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Distal humeral fractures treated with noncustom Total Elbow Replacement.
The Journal of bone and joint surgery. American volume, 2020Co-Authors: S Kamineni, B F MorreyAbstract:The purpose of this study was to review the cases of patients with a distal humeral fracture that was treated with a noncustom Total Elbow arthroplasty. We hypothesized that, on the basis of the functional and clinical outcome, Total Elbow Replacement is a reliable option for the treatment of elderly patients with a severe, comminuted fracture of the distal part of the humerus. We retrospectively reviewed forty-nine acute distal humeral fractures in forty-eight patients who were treated with Total Elbow arthroplasty as the primary option. The average age of the patients was sixty-seven years. Forty-three fractures were followed for at least two years. According to the AO classification, five fractures were type A, five were type B, and thirty-three were type C. The average age of the forty-three patients was sixty-nine years and the average duration of follow-up was seven years. Fourteen patients died during the review period. Postoperative clinical function was assessed with use of the Mayo Elbow performance score, and anteroposterior and lateral radiographs made at follow-up examinations were reviewed. At the latest follow-up examination, the average flexion arc was 24 degrees (range, 0 degrees to 75 degrees ) to 131 degrees (range, 100 degrees to 150 degrees ) and the Mayo Elbow performance score averaged 93 of a possible 100 points. Heterotopic ossification was present to some extent in seven Elbows, with radiographic abutment noted in two. Thirty-two (65%) of the forty-nine Elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Fourteen Elbows (29%) had a single complication, and most of them did not require further surgery. Ten additional procedures, including five revision arthroplasties, were required in nine Elbows; five were related to soft tissue and five were related to the implant or bone. Complex distal humeral fractures should be assessed primarily for the reliability with which they can be reconstructed with osteosynthesis. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, Total Elbow arthroplasty can be considered. This retrospective review supports a recommendation for Total Elbow arthroplasty for the treatment of an acute distal humeral fracture when strict inclusion criteria are observed.
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revision of Total Elbow Replacement by exchange cementing
Journal of Bone and Joint Surgery-british Volume, 2012Co-Authors: A A Malone, J S Sanchez, Robert A Adams, B F MorreyAbstract:We report the effectiveness of revision of Total Elbow Replacement by re-cementing. Between 1982 and 2004, 53 Elbows in 52 patients were treated with re-cementing of a Total Elbow Replacement into part or all of the existing cement mantle or into the debrided host-bone interface, without the use of structural bone augmentation or a custom prosthesis. The original implant revision was still in situ and functional in 42 of 53 Elbows (79%) at a mean of 94.5 months (26 to 266) after surgery. In 31 of these 42 Elbows (74%) the Mayo Elbow Performance Score was good or excellent. Overall, of the 53 Elbows, 18 (34%) required re-operation, ten (19%) for loosening. A classification system was developed to identify those not suitable for revision by this technique, and using this we have showed that successful re-implantation is statistically correlated to properly addressing the bone deficiency for both the humeral (p = 0.005) and the ulnar (p = 0.039) components.
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complications of Total Elbow Replacement a systematic review
Journal of Shoulder and Elbow Surgery, 2011Co-Authors: Ilya Voloshin, David W Schippert, Sanjeev Kakar, Elizabeth Krall Kaye, B F MorreyAbstract:Total Elbow arthroplasty (TEA) is becoming an increasingly popular reconstructive procedure. Improved surgical techniques, newer implant designs, and improving clinical results have each contributed to the rise in prevalence of this surgical intervention. Themost common indication remains rheumatoid arthritis (RA). However, with the advent of semiconstrained prostheses, the indications have expanded to include post-traumatic sequelae such as instability and arthritis, as well as acute comminuted distal humerus fractures in the elderly. The rate of complications following TEA, ranging from 20% to 45%, is higher than in other large joint Replacements. In their review of the literature, Gschwend et al reported a complication rate of 43% including aseptic loosening, infections, ulnar nerve complications, instability, disassembly, dislocation, subluxation, intraoperative fractures, fractures of the prosthesis, and ectopic bone formation. In order to reduce these complications, a variety of technical advances have been made within the last decade in the areas of prosthetic design and surgical technique. Fully constrained prostheses have fallen out of favor due to their high rates of aseptic loosening. They have been largely replaced by linked and unlinked components. The linked prostheses are semi-constrained and utilize ‘‘sloppy hinges,’’ which both decrease the rate of aseptic
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Total Elbow Replacement for the management of the ankylosed or fused Elbow
Journal of Bone and Joint Surgery-british Volume, 2008Co-Authors: J P Peden, B F MorreyAbstract:This study reports our experience with Total Elbow Replacement for fused Elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed Elbows were treated with a linked semi-constrained non-custom Total Elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten Elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37° of extension to 118° of flexion was achieved. Outcomes were good or excellent for seven Elbows at final review. Ten patients felt better or much better after Total Elbow Replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one Elbow following fracture of the ulnar component. Three patients developed a deep infection. Three Elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total Elbow Replacement for the ankylosed Elbow should be performed with caution. However, the outcome can be reliable in the long term and have a markedly positive impact on patient function and satisfaction. The high potential for complications must be considered. We consider Total Elbow Replacement to be an acceptable procedure in selected patients with reasonable expectations.
D Stanley - One of the best experts on this subject based on the ideXlab platform.
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pin disassembly of the coonrad morrey Total Elbow Replacement failure mechanism and risk factors
Shoulder & Elbow, 2012Co-Authors: Shyam Kumar, Sophy Rymaruk, D StanleyAbstract:BackgroundDisassembly of the Coonrad-Morrey Total Elbow Replacement with the pin in pin locking mechanism has previously been reported. We present the largest series documented to date with failure of this mechanism.MethodsA retrospective review of patients treated at the shoulder and Elbow unit of the Northern General Hospital Sheffield UK.ResultsThere were five men and one woman with a mean age at pin failure of 56 years (range 39 years to 79 years). One patient had failure of bilateral Replacements and two patients had failure on two separate occasions. Three patients had undergone surgery for distal humeral fractures, two for non-inflammatory arthritis and one for rheumatoid arthritis. All patients required revision surgery. A mechanism of pin failure is proposed and the risk factors are identified.ConclusionDespite the redesign of the locking mechanism of the Coonrad-Morrey Total Elbow arthroplasty, there remains a risk of pin failure. This would appear to be greatest in younger male patients undergo...
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the kudo 5 Total Elbow Replacement in the treatment of the rheumatoid Elbow results at a minimum of ten years
Journal of Bone and Joint Surgery-british Volume, 2010Co-Authors: F Qureshi, K P Draviaraj, D StanleyAbstract:Between September 1993 and September 1996, we performed 34 Kudo 5 Total Elbow Replacements in 31 rheumatoid patients. All 22 surviving patients were reviewed at a mean of 11.9 years (10 to 14). Their mean age was 56 years (37 to 78) at the time of operation. All had Larsen grade IV or V rheumatoid changes on X-ray. Nine (three bilateral Replacements and six unilateral) had died from unrelated causes. One who had died before ten years underwent revision for dislocation. Of the 22 Total Elbow Replacements reviewed six had required revision, four for aseptic loosening (one humeral and three ulnar) and two for infection. Post-operatively, one patient had neuropraxia of the ulnar nerve and one of the radial nerve. Two patients had valgus tilting of the ulnar component. With revision as the endpoint, the mean survival time for the prosthesis was 11.3 years (95% confidence interval (10 to 13) and the estimated survival of the prosthesis at 12 years according to Kaplan-Meier survival analysis was 74% (95% confidence interval 0.53 to 0.91). Of the 16 surviving implants, ten were free from pain, four had mild pain and two moderate. The mean arc of flexion/extension of the Elbow was 106° (65° to 130°) with pronation/supination of 90° (30° to 150°) with the joint at 90° of flexion. The mean Mayo Elbow performance score was 82 (60 to 100) with five excellent, ten good and one fair result. Good long-term results can be expected using the Kudo 5 Total Elbow Replacement in patients with rheumatoid disease, with a low incidence of loosening of the components.
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Total Elbow Replacement using the kudo prosthesis
Journal of Bone and Joint Surgery-british Volume, 2003Co-Authors: D Potter, P Claydon, D StanleyAbstract:Between 1993 and 1996, we undertook 35 Kudo 5 Total Elbow Replacements in a consecutive series of 31 rheumatoid patients. A Total of 25 patients (29 procedures) was evaluated at a mean follow-up of six years (5 to 7.5) using the Mayo Clinic performance index. In addition, all patients were assessed for loosening using standard anteroposterior and lateral radiographs.At review, 19 Elbows (65%) had either no pain or mild pain, ten (35%) had moderate pain and none had severe pain. The mean arc of flexion/extension was 94° (35 to 130) and supination/pronation was 128° (30 to 165).A fracture of the medial epicondyle occurred during surgery in one patient. This was successfully treated with a single AO screw and a standard Kudo 5 implant was inserted. Postoperatively, there were no infections. One patient had a dislocation which was treated by closed reduction and five had neurapraxia of the ulnar nerve.Radiologically, there was no evidence of loosening of the humeral component, but two ulnar components had pro...
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complex fractures of the distal humerus in the elderly the role of Total Elbow Replacement as primary treatment
Journal of Bone and Joint Surgery-british Volume, 2002Co-Authors: J A Garcia, R Mykula, D StanleyAbstract:Between 1995 and 2000, 19 consecutive patients with fractures of the distal humerus were treated by primary Total Elbow Replacement using the Coonrad-Morrey prosthesis. No patient had inflammatory or degenerative arthritis of the Elbow. The mean age at the time of injury was 73 years (61 to 95). According to the AO classification, 11 patients had suffered a C3 injury, two a B3 and two an A3. One fracture was unclassified. Two patients died from unrelated causes and one was unable to be assessed because of concurrent illness. The mean time to follow-up was three years (1 to 5.5). At follow-up 11 patients (68%) reported no pain, four (25%) had mild pain with activity and one had mild pain at rest. The mean flexion arc was 24° to 125°. The mean supination was 90° (70 to 100) and pronation 70° (50 to 110). No Elbow was unstable. The mean Disabilities of the Arm, Shoulder and Hand score was 23 (0.92 to 63.3) and the mean Mayo Elbow performance score was 93 (80 to 100). Of the 16 patients, 15 were satisfied with the outcome. Radiological evaluation revealed only one patient with a radiolucent line at the cement-bone interface. It was between 1 and 2 mm in length, was present on the initial postoperative radiograph and was non-progressive at the time of follow-up. Primary Total Elbow arthroplasty is an acceptable option for the management of comminuted fractures of the distal humerus in elderly patients when the configuration of the fracture and the quality of the bone make reconstruction difficult.
C Dent - One of the best experts on this subject based on the ideXlab platform.
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OUTCOME OF Total Elbow Replacement FOR DISTAL HUMERUS FRACTURES; A COMPARISON OF EARLY WITH DELAYED SURGERY
2020Co-Authors: N. Prasad, C DentAbstract:We analysed the outcome of the Coonrad-Morrey Total Elbow Replacement used for fracture of the distal humerus in elderly patients with no evidence of inflammatory arthritis and compared the results for early versus delayed treatment. We studied a Total of 32 patients with 15 in the early treatment group and 17 in the delayed treatment group. The mean follow-up was 56.1 months (18 to 88). The percentage of excellent to good results based on the Mayo Elbow performance score was not significantly different, 84% in the early group and 79% in the delayed group. Subjective satisfaction was 92% in both the groups. One patient in the early group developed chronic regional pain syndrome and another type 4 aseptic loosening. Two Elbows in the early group also showed type 1 radiological loosening. Two patients in the delayed group had an infection, two an ulnar nerve palsy, one developed heterotopic ossification and one type 4 aseptic loosening. Two Elbows in this group also showed type 1 radiological loosening. The complication rates in the early and delayed treatment group were 13% and 29% respectively. The Kaplan-Meier survivorship analysis for the early and delayed treatment groups was 93% at 88 months and 76% at 84 months, respectively. No statistically significant difference was found between the two groups. We conclude that Total Elbow Replacement provides a preditable and reproducible outcome in terms of pain relief and functional range of movement in elderly osteoporotic patients with difficult distal humerus fractures.
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outcome of Total Elbow Replacement for rheumatoid arthritis single surgeon s series with souter strathclyde and coonrad morrey prosthesis
Journal of Shoulder and Elbow Surgery, 2010Co-Authors: Narayana Prasad, C DentAbstract:Background The reported outcome of Total Elbow Replacement is inferior to hip and knee arthroplasty, and there might be an element of institutional bias. Methods We analyzed the outcome of Souter and Coonrad-Morrey Total Elbow prosthesis in rheumatoid Elbow performed by a single surgeon from a center independent from standpoint of being involved in the designing or manufacturing of the implant. Results We had 44 Souter Elbows with a mean follow-up of 108 months and 55 Coonrad-Morrey Elbows with mean follow-up of 60 months. The Mayo Elbow Performance Score was comparable in both the groups with similar subjective satisfaction. Souter Elbow showed a survivorship of 92.9% at 5 years and 76% at 10 years, with aseptic loosening rate of 18% and instability of 9% as main reasons for the failure. The Coonrad-Morrey Elbow shows 100% survival at mean follow-up of 5 years in our series. Conclusion We find high rate of instability and loosening of Souter prosthesis with an inferior 5-year survival compared to Coonrad-Morrey prosthesis.
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Total Elbow Replacement for distal humeral fractures
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: H V Dabke, S Sarasin, M Pritchard, R Kulkarni, C DentAbstract:Aim: To study the role of Total Elbow Replacement in the management of distal humeral fractures in elderly patients.Patients and methods: Between 1995 and 2003, 25 consecutive patients with fractures of the distal humerus were treated by primary Total Elbow Replacement using the Coonrad-Morrey prosthesis. All surgeries were performed by one of the senior authors in two centers in South Wales. There were 18 females and 7 males and none of them had inflammatory or degenerative arthritis of the Elbow. The mean age at the time of injury was 78 years (68–84). According to the AO classification, 16 patients had suffered a C3 injury, five type B3 and three type A3. One fracture was unclassified. The mean time to follow-up was 4 years (1–9 years).Results: At follow-up 19 patients (76%) reported no pain, five (20%) had mild pain with activity and one had mild pain at rest. The mean flexion arc was 28 degrees to 105 degrees. The mean supination was 69 degrees (50–90) and pronation 70 degrees (50–80). No Elbow was u...
I A Trail - One of the best experts on this subject based on the ideXlab platform.
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Outcome of revision Total Elbow Replacement using the Acclaim
2020Co-Authors: J. Hearnden, I A Trail, Aravind S. Desai, John W. K. Harrison, Asterios Dramis, Michael J. Hayton, J K StanleyAbstract:Background This was a retrospective study presenting our results and survivorship of the Acclaim Total Elbow when used as a revision implant.
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early results of latitude primary Total Elbow Replacement with a minimum follow up of 2 years
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Saurabh Sagar Mehta, D Nuttall, Adam C Watts, S C Talwalkar, A Birch, I A TrailAbstract:Background The aim of this study was to present outcomes of primary Latitude Total Elbow Replacement (TER) with a minimum follow-up of 2 years. Methods A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital. Results The mean age of the patients was 62 years (33-85 years). Five primary TERs (4 patients) were lost to follow-up. The primary diagnosis was rheumatoid arthritis in 49, osteoarthritis in 8, and trauma in 6 Elbows. The mean flexion-extension arc was 75° preoperatively and 97° postoperatively. Mean postoperative Elbex pain score was 19/100, and function score was 37/100. Mean postoperative scores were 42/100 for the Quick Disabilities of the Arm, Shoulder, and Hand and 38/50 for the Elbow-specific American Shoulder and Elbow Surgeons assessment. Four patients died of unrelated causes, and 8 of 63 underwent further surgical intervention, including explantation and conversion from unlinked to linked implant. On radiographic review of 41 surviving TERs, aseptic radiologic loosening was observed of the humeral component in 4 Elbows and of the ulnar component in 9. Seven Elbows had no radial component, and of the remaining 34 Elbows, 16 (47%) had signs of loosening of the radial implant. Complications included 1 heterotopic ossification, 1 olecranon fracture, and 3 further procedures for ulnar nerve entrapment. Conclusion The results indicate that the early outcome of Latitude TER is comparable to that of other prostheses. There is concern about early radiologic loosening of the radial component.
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modified posterior approach for Total Elbow Replacement
Shoulder & Elbow, 2015Co-Authors: Manickam Rathinam, I A TrailAbstract:Surgical exposure for Total Elbow Replacement should provide complete visualization of the joint surfaces. The soft tissue reconstruction following Replacement often requires protection and can lead to complications such as triceps tendon rupture. We describe a modification of the posterior approach to the Elbow that provides optimal exposure and allows early mobilization.
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early results of the acclaim Total Elbow Replacement in patients with primary osteoarthritis
Journal of Bone and Joint Surgery-british Volume, 2010Co-Authors: S Z Naqui, A Rajpura, D Nuttall, P Prasad, I A TrailAbstract:This is a retrospective review of the results of the Acclaim Total Elbow Replacement in 11 older patients aged ≥ 65 years with primary osteoarthritis of the Elbow, with a mean follow-up of 57.6 months (30 to 86.4). Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved. This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged ≥ 65 years with primary osteoarthritis of the Elbow.
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outcome of revision Total Elbow Replacement using the acclaim prosthesis
Shoulder & Elbow, 2009Co-Authors: A Hearnden, I A Trail, Aravind S. Desai, John W. K. Harrison, Asterios Dramis, Michael J. Hayton, J K StanleyAbstract:Background This was a retrospective study presenting our results and survivorship of the Acclaim Total Elbow when used as a revision implant. Methods Between May 2001 and July 2005, 29 revision Elbow Replacements were carried out on 28 patients in our institution. Five were redo revisions and one received the fourth sequential implant. A variety of implants were removed for aseptic loosening (17), periprosthetic fracture (7), dislocation (3) and infection (2). Two patients had died and one was unavailable for follow-up. Results At a mean follow-up of 50 months (12 to 80 months) pain, functional assessment scores and radiographs were assessed and a Kaplan-Meier survival curve created. Symptoms were reliably relieved with 72% reporting no pain. Mean flexion was 128° with loss of full extension of 34°. Complications were noted in six cases of which three patients underwent further surgery. None of the 29 revisions has been re-revised till date. Conclusion The medium term results for this implant suggest it is an effective revision prosthesis.
Omid Alizadehkhaiyat - One of the best experts on this subject based on the ideXlab platform.
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outcome of Total Elbow Replacement a four year mean follow up
Orthopaedic Proceedings, 2018Co-Authors: Omid Alizadehkhaiyat, K Vishwanathan, Simon P FrostickAbstract:Summary StatementDiscovery system produced effective functional improvement in both primary and revision Total Elbow Replacement. The incidence of major complications was in an acceptable range.IntroductionThe search for the ideal Elbow prosthesis continues as instability and loosening remain the prime reasons for Total Elbow Replacement (TER) failure. The Discovery Elbow System (Biomet) is one of the latest generations of linked prosthesis and has been used in UK since 2003. We report outcome of TER using this system.MethodsA Total of 100 TERs (75 primary, 25 revisions) were performed between 2003 and 2010. The main primary underlying pathologies for TER were advanced rheumatoid arthritis (N=58), osteoarthritis (N=35), acute fractures (N=7). There were 60 female and 40 male patients with an average age of 62 years. The outcome assessment included pain, patient satisfaction, Liverpool Elbow Score (LES), range of movement, and imaging during a mean follow-up period of 48.5 months. Major complications are a...
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outcome of Total Elbow Replacement a four year mean follow up
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Omid Alizadehkhaiyat, K Vishwanathan, Simon P FrostickAbstract:Summary Statement Discovery system produced effective functional improvement in both primary and revision Total Elbow Replacement. The incidence of major complications was in an acceptable range. Introduction The search for the ideal Elbow prosthesis continues as instability and loosening remain the prime reasons for Total Elbow Replacement (TER) failure. The Discovery Elbow System (Biomet) is one of the latest generations of linked prosthesis and has been used in UK since 2003. We report outcome of TER using this system. Methods A Total of 100 TERs (75 primary, 25 revisions) were performed between 2003 and 2010. The main primary underlying pathologies for TER were advanced rheumatoid arthritis (N=58), osteoarthritis (N=35), acute fractures (N=7). There were 60 female and 40 male patients with an average age of 62 years. The outcome assessment included pain, patient satisfaction, Liverpool Elbow Score (LES), range of movement, and imaging during a mean follow-up period of 48.5 months. Major complications are also reported. Results For the whole patient group (primary + revision), the LES was significantly (p p Discussion TER using the Discovery Elbow System is an effective arthroplasty in terms of functional improvement, pain relief and range of motion in both primary and revision patients. TER resulted in no/mild pain in 78% of cases. Patients undergoing Acclaim, Souter-Strathclyde, GSB III, and Coonrad-Morrey TER have been reported to have no/mild pain in 64%, 67%, 50–92% and 60–100% of cases, respectively. A 20° improvement in flexion-extension arc is comparable to that of Acclaim (23°), Souter-Strathclyde (15°), GSBIII (19–33°), and Coonrad-Morrey (17–26°) TER. An improvement of 25° in pronation-supination arc in our series is also comparable to that of 21–28° reported the Coonrad-Morrey and 27–33° for Discovery prostheses. An infection rate of 2% is lower than several other reports for GSB III TER (7–11%) and Coonrad-Morrey (6–8%). The incidence of persistent ulnar neuropathy (3%) was lower compared to GSBIII TER (11–14%), Coonrad-Morrey (12–26%), and Acclaim (8%).
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discovery Elbow system outcome of Total Elbow Replacement
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: Omid Alizadehkhaiyat, K Vishwanathan, Simon P Frostick, Ahmed Al MandhariAbstract:Background The quest for the perfectly designed Elbow prosthesis continues as instability and loosening remain the foremost reasons for the failure of Total Elbow Replacement (TER). The Discovery® Elbow System (Biomet, UK) (Figure 1), which has been used in UK since 2003, is one of the latest generations of linked prosthesis. This system was designed to decrease polyethylene-bushing wear, improve anatomic stem design, restore Elbow joint biomechanics, and produce a hinge that could be easily revised. This report describes the short term outcome of TER using the Discovery® Elbow System. Patients and Methods A Total of 60 TERs including 48 primary and 12 revisions were performed between 2003 and 2008. Patients included 21 males (37%) and 36 females (63%) with a mean age of 63 years. The indications for primary TER were advanced rheumatoid arthritis (n=19), osteoarthritis (n=16), post traumatic osteoarthritis (n=9), acute fractures (n=3), and haemophilic arthropathy (n=1). The outcome was assessed using pain score, Liverpool Elbow Score (LES), and range of movement during a mean follow-up of 26 months. Associated complications were documented. Radiological assessment included evaluation for loosening, instability and periprosthetic fractures. Results The mean LES was significantly (p Discussion TER with Discovery® Elbow System resulted in either no pain or mild pain in 87% of cases. Patients undergoing Acclaim, Souter-Strathclyde, GSB III, and Coonrad-Morrey TER have been reported to have no/mild pain in 64%, 67%, 50–92% and 60–100% of cases, respectively. A 22° improvement in flexion-extension arc is comparable to that of Acclaim (23°), Souter-Strathclyde (15°), GSB III (19–33°), and Coonrad-Morrey (17–26°) TER. An improvement of 44° in pronation-supination arc in our series is also comparable to that of 31–67° reported for GSB III and higher than the Coonrad-Morrey prosthesis (21–28°). In terms of complications, an infection rate of 6.7% is consistent with those reported for GSB III TER (7–11%) and Coonrad-Morrey (6–8%). The incidence of persistent ulnar neuropathy was lower compared to GSB III TER (11–14%), Coonrad-Morrey (12–26%), and Acclaim (8%). While the survival of Discovery TER was 93%, the survival of GSB III (5–6 years) and Coonrad-Morrey (5 years) has been reported as 71–85% and 72–90%. The results indicate that Discovery® Elbow System is an effective device for Total Elbow arthroplasty in terms of functional improvement, pain relief and range of motion at short-term follow-up.
