Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
J Hand Surg Am. 2022 Dec;47(12):1146-1156. doi: 10.1016/j.jhsa.2022.07.020. Epub 2022 Oct 8.
To assess the association between cement mantle characteristics and early radiographic loosening in total elbow arthroplasty (TEA). We aimed to determine whether shorter mantle heights (<20 mm) were associated with loosening.
We reviewed primary TEAs from a single healthcare system from 2006 to 2020. TEAs complicated by infection or performed for oncologic conditions were excluded. Initial postoperative radiographs were reviewed to determine cement mantle and component characteristics (mantle quality, mantle height, and component angulation). One-year postoperative radiographs were reviewed to assess for implant loosening, and we compared demographics and radiographic criteria for cases with and without early loosening. We noted whether cases underwent subsequent revision for aseptic osteolysis.
A total of 54 TEA cases were included. Forty percent of ulnar and 24% of humeral mantles were classified as short (between 1 and 19 mm). According to the Morrey classification, 6 (11%) cases had an inadequate cement mantle Twenty-four (45%) cases had radiographic evidence of loosening at 1 year. Of the cases with early loosening, 6 (25%) had initial inadequate mantle quality. There were no inadequate mantles in the group without loosening. There were no statistically significant differences in mantle heights for cases with and without loosening at 1 year after surgery. Eight (33%) cases underwent revision in the group with early loosening compared with 1 (3%) case without early loosening.
Inadequate cement mantle quality was associated with an increased risk of early aseptic loosening after primary TEA. Cement mantles that extended past the tip of the prosthesis were not associated with loosening. Considering the potential need for future revision and morbidity of cement removal, surgeons should focus on mantle quality and carefully plan mantle height because shorter heights may not be associated with early implant failure.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
评估全肘关节置换术（TEA）中骨水泥套特征与早期放射学松动之间的关系。我们旨在确定较短的骨水泥套高度（<20mm）是否与松动有关。
我们回顾了 2006 年至 2020 年期间来自单一医疗保健系统的原发性 TEA。排除感染或因肿瘤原因进行的 TEA。回顾初始术后 X 线片以确定骨水泥套和组件特征（骨水泥套质量、骨水泥套高度和组件角度）。评估术后 1 年的 X 线片以评估植入物松动情况，并比较有无早期松动病例的人口统计学和影像学标准。我们注意到是否有病例因无菌性骨溶解而行后续翻修。
共纳入 54 例 TEA 病例。40%的尺骨和 24%的肱骨骨水泥套被归类为短套（1-19mm 之间）。根据 Morrey 分类，24%的病例有不足的骨水泥套。24%的病例在术后 1 年有放射学松动证据。在早期松动的病例中，6 例（25%）初始骨水泥套质量不足。在无松动的病例中，无不足的骨水泥套。术后 1 年，松动病例与无松动病例的骨水泥套高度无统计学差异。在早期松动组中，有 8 例（33%）病例行翻修，而在无早期松动组中，仅 1 例（3%）病例行翻修。
在原发性 TEA 后，骨水泥套质量不足与早期无菌性松动的风险增加有关。超出假体尖端的骨水泥套与松动无关。考虑到未来翻修的潜在需求和骨水泥去除的发病率，外科医生应关注骨水泥套质量，并仔细规划骨水泥套高度，因为较短的骨水泥套高度可能与早期植入物失败无关。
类型的研究/证据水平：预后 II 级。
