Indiana Hand to Shoulder Center, Indianapolis, IN, USA.
Vanderbilt University School of Medicine, Nashville, TN, USA.
J Shoulder Elbow Surg. 2014 May;23(5):e95-e107. doi: 10.1016/j.jse.2013.12.033.
Semiconstrained total elbow arthroplasty is used to improve elbow function and reduce pain. Although effective, high complication rates exist, with the polyethylene bushing especially susceptible to failure. The Discovery Elbow System (Biomet Inc, Warsaw, IN, USA) contains a spherical bearing designed to minimize polyethylene wear. This prospective, multicenter clinical study investigated the 4-year (mean) outcomes of this elbow.
From 2002 to 2009, 92 patients (71 women, 21 men; mean age, 63.9 years; range, 33.4-88.7 years) received 99 Discovery elbows at 4 centers. The study cohort was limited to 46 elbows with complete preoperative and minimum 2-year clinical (modified American Shoulder and Elbow Surgeons elbow score) and radiographic follow-up.
Mean follow-up was 4.1 years (range, 2-5.9 years). All American Shoulder and Elbow Surgeons elbow score components improved significantly (P < .001). Mean flexion-extension arcs increased from 81° to 121° and pronation-supination arcs from 134° to 163° (P < .001). Loose locking screws in 2 elbows (first-generation screws), a loose polyethylene bearing in 1 (history of falls), and a condyle/bearing in 1 (deep infection) were exchanged. Among the 46 elbows, gross survivorship was humeral/ulnar components, 100%; condyles, 97.8%; bearings, 95.7%; and screws, 95.7%. One humeral component (2.2%) was radiographically loose but not revised. An additional elbow (elbow 47) that did not meet the criteria for inclusion (<2 years of follow-up) was revised due to a loose humeral component and was reported separately.
The Discovery elbow increased function and decreased pain with high survivorship at a mean of 4.1 years.
半限制型全肘关节置换术用于改善肘关节功能并减轻疼痛。虽然效果显著，但仍存在较高的并发症发生率，其中聚乙烯衬垫尤其容易失效。Discovery 肘关节系统（Biomet Inc，美国印第安纳州华沙）包含一个球形轴承，旨在最大程度地减少聚乙烯磨损。本前瞻性、多中心临床研究调查了该款肘部假体 4 年（平均）的结果。
2002 年至 2009 年，4 个中心的 92 名患者（71 名女性，21 名男性；平均年龄 63.9 岁；范围 33.4-88.7 岁）接受了 99 个 Discovery 肘部假体。该研究队列仅限于 46 个具有完整术前和至少 2 年临床（改良美国肩肘外科医师肘关节评分）和放射学随访的肘部假体。
平均随访时间为 4.1 年（范围 2-5.9 年）。所有美国肩肘外科医师肘关节评分的各个组成部分均显著改善（P<.001）。平均屈伸弧从 81°增加到 121°，旋前-旋后弧从 134°增加到 163°（P<.001）。2 个肘部假体（第一代螺钉）的锁定螺钉松动，1 个肘部假体的聚乙烯衬垫松动（有跌倒史），1 个肘部假体的髁骨/轴承松动（深部感染），均进行了更换。在 46 个肘部假体中，肱骨/尺骨组件的总生存率为 100%，髁骨为 97.8%，轴承为 95.7%，螺钉为 95.7%。1 个肱骨组件（2.2%）影像学上松动但未进行翻修。另外 1 个（第 47 个肘部）由于肱骨组件松动而未达到纳入标准（<2 年随访），单独进行了翻修。
在平均 4.1 年的随访中，Discovery 肘部假体增加了功能，减轻了疼痛，且具有较高的生存率。
