Long-term Outcomes and Trends in Elbow Arthroplasty with Coonrad-Morrey Prosthesis: a Retrospective Study in Large Group of Patients

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2024 Aug 22

PMID 39172271

Authors

Luigi Tarallo

Andrea Celli

Matilde Delvecchio

Lorenzo Costabile

Grazia Ciacca

Giuseppe Porcellini

Fabio Catani

Affiliations

Soon will be listed here.

Abstract

Purpose: Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history.

Methods: We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up.

Results: Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement.

Conclusion: Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.

References

Young B, Watson S, Perez J, McGwin G, Singh J, Ponce B . Trends in Joint Replacement Surgery in Patients with Rheumatoid Arthritis. J Rheumatol. 2017; 45(2):158-164. DOI: 10.3899/jrheum.170001. View

Harmer L, Sanchez-Sotelo J . Total Elbow Arthroplasty for Distal Humerus Fractures. Hand Clin. 2015; 31(4):605-14. DOI: 10.1016/j.hcl.2015.06.008. View

Kapetanovic M, Lindqvist E, Saxne T, Eberhardt K . Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement. Ann Rheum Dis. 2008; 67(10):1412-6. DOI: 10.1136/ard.2007.086710. View

Jenkins P, Watts A, Norwood T, Duckworth A, Rymaszewski L, McEachan J . Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop. 2013; 84(2):119-23. PMC: 3639330. DOI: 10.3109/17453674.2013.784658. View

Gill D, Morrey B . The Coonrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year follow-up study. J Bone Joint Surg Am. 1998; 80(9):1327-35. DOI: 10.2106/00004623-199809000-00012. View

Zhang Q, Xiang M, Yang J, Dai F . Clinical and Radiographic Outcomes of Total Elbow Arthroplasty Using a Semi-constrained Prosthesis with a Triceps-preserving Approach over a Minimum Follow-up Period of 4 Years. Orthop Surg. 2023; 15(8):2091-2101. PMC: 10432419. DOI: 10.1111/os.13698. View

Booker S, Smith C . Triceps on approach for total elbow arthroplasty: worth preserving? A review of approaches for total elbow arthroplasty. Shoulder Elbow. 2017; 9(2):105-111. PMC: 5384537. DOI: 10.1177/1758573216682479. View

Cusick M, Bonnaig N, Azar F, Mauck B, Smith R, Throckmorton T . Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg Am. 2014; 39(6):1146-50. DOI: 10.1016/j.jhsa.2014.01.041. View

Kholinne E, Arya A, Jeon I . Complications of modern design total elbow replacement. J Clin Orthop Trauma. 2021; 19:42-49. PMC: 8176365. DOI: 10.1016/j.jcot.2021.05.008. View

10.

Sanchez-Sotelo J, Baghdadi Y, Morrey B . Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis: A Single-Institution Experience with 461 Elbows Over Three Decades. J Bone Joint Surg Am. 2016; 98(20):1741-1748. PMC: 5065309. DOI: 10.2106/JBJS.15.00649. View

11.

Toulemonde J, Ancelin D, Azoulay V, Bonnevialle N, Rongieres M, Mansat P . Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases. Int Orthop. 2015; 40(1):73-80. DOI: 10.1007/s00264-015-3008-z. View

12.

Chen Q, Liu L, Gu F . Prevalence of wound infections and postoperative complications after total elbow arthroplasty for rheumatoid arthritis: A meta-analysis. Int Wound J. 2023; . PMC: 10828120. DOI: 10.1111/iwj.14451. View

13.

Mansat P, Bonnevialle N, Rongieres M, Mansat M, Bonnevialle P . Experience with the Coonrad-Morrey total elbow arthroplasty: 78 consecutive total elbow arthroplasties reviewed with an average 5 years of follow-up. J Shoulder Elbow Surg. 2013; 22(11):1461-8. DOI: 10.1016/j.jse.2013.07.042. View

14.

Hudak P, Amadio P, Bombardier C . Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996; 29(6):602-8. DOI: 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L. View

15.

Cao S, Zhou R, Zhou H, Chen Y, Cui H, Lu Z . Reliability and validity of Simplified Chinese version of Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire: cross-cultural adaptation and validation. Clin Rheumatol. 2019; 38(11):3281-3287. DOI: 10.1007/s10067-019-04661-8. View

16.

Dachs R, Fleming M, Chivers D, Carrara H, du Plessis J, Vrettos B . Total elbow arthroplasty: outcomes after triceps-detaching and triceps-sparing approaches. J Shoulder Elbow Surg. 2015; 24(3):339-47. DOI: 10.1016/j.jse.2014.11.038. View

17.

Dehghan N, Furey M, Schemitsch L, Ristevski B, Goetz T, Schemitsch E . Long-term outcomes of total elbow arthroplasty for distal humeral fracture: results from a prior randomized clinical trial. J Shoulder Elbow Surg. 2019; 28(11):2198-2204. DOI: 10.1016/j.jse.2019.06.004. View

18.

Badre A, King G . Primary total elbow arthroplasty. J Clin Orthop Trauma. 2021; 18:66-73. PMC: 8099774. DOI: 10.1016/j.jcot.2021.04.015. View

19.

Samdanis V, Manoharan G, Jordan R, Watts A, Jenkins P, Kulkarni R . Indications and outcome in total elbow arthroplasty: A systematic review. Shoulder Elbow. 2020; 12(5):353-361. PMC: 7545529. DOI: 10.1177/1758573219873001. View

20.

Beaton D, Wright J, Katz J . Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005; 87(5):1038-46. DOI: 10.2106/JBJS.D.02060. View