Lee Brian P, Adams Robert A, Morrey Bernard F
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2005 May;87(5):1080-7. doi: 10.2106/JBJS.D.02163.
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.
A review of the results of 919 replacements with the semi-constrained 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.
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 degrees before the surgery to 109 degrees 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.
Isolated bushing exchange can be a successful revision procedure in patients with a semi-constrained 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.
关节磨损被认为是使用带柄的、可矫正畸形并恢复功能的耦合式肘关节置换假体可能出现的一种长期并发症。据我们所知，此前尚无关于该主题的报道。
回顾1981年至2000年间使用半限制型连接式Coonrad-Morrey全肘关节假体进行的919例置换手术的结果，发现12例患者（1.3%）因聚乙烯磨损而接受了单纯的关节衬套置换。对这些患者的情况进行了临床和影像学评估。
这12例患者初次全肘关节置换时的平均年龄为44岁，而整个研究组的平均年龄为62岁（p < 0.001）。12例患者中有7例患有创伤后关节炎，5例患有类风湿关节炎。9例患者有严重畸形。该组包括7名女性和5名男性，10例患者右侧优势肘关节受累。衬套翻修时的平均年龄为52岁，衬套植入后平均7.9年进行翻修。所有12例患者均报告有疼痛，5例报告有摩擦音或吱吱声。均无广泛的骨溶解。衬套置换后的平均随访时间为65个月。平均活动弧度从手术前的89度提高到手术后的109度。12例患者中有3例在初次衬套置换后的53、54和136个月又进行了一次关节翻修。在最后随访时，所有12例患者的肘关节功能均良好。
对于半限制型连接式全肘关节假体患者，单纯的衬套置换可以是一种成功的翻修手术。患有创伤后疾病和/或术前存在严重畸形的年轻患者发生衬套过度磨损的风险更高。应告诫患者不要超过推荐的活动和提举限制。
