Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
Int Orthop. 2024 Feb;48(2):537-545. doi: 10.1007/s00264-023-06015-1. Epub 2023 Oct 28.
Linked component of total elbow arthroplasty (TEA) consisted of bushing and locking pins. Failure of linked components is a rare complication of TEA. This study aims to investigate the mechanism and consequence of failure of the linkage mechanism in TEA surgeries.
Between 2010 and 2021, five patients received revision operation due to linked component failure. Besides, two patients underwent primary operation at another institute were also analyzed due to failure of the linkage mechanism.
All seven patients underwent primary TEA and mean age for primary TEA was 48 (range, 27-62). Two patients had TEA for post-traumatic arthritis, three patients for rheumatoid arthritis, and two patients for comminuted distal humerus fracture. The average time between primary TEA and revision TEA for linked component failure was 13.6 years. Three bushing wear and four locking pin dissociation were diagnosed according to pre-operative radiography. Elbow pain and swelling are the most common clinical symptoms. Severe osteolysis, periprosthetic fracture, and stem loosening were noted in three bushing wear cases. In four dissociation of locking pin cases, breakage of male locking pin phalanges was demonstrated in two patients. For revision procedures, both the locking pins and bushings were replaced. No patients in the study required additional surgery after the revision operation for linked component failure.
Osteolysis, component loosening, periprosthetic fracture may be expected after linked component failure. Patients should be regularly followed up from short-term to long-term with radiography. Early diagnosis and intervention with linked component exchange can prevent extensive revision surgery.
全肘关节置换术（TEA）的连接部件包括衬套和锁定销。连接部件的故障是 TEA 的罕见并发症。本研究旨在探讨 TEA 手术中连接机制故障的机制和后果。
2010 年至 2021 年间，5 例患者因连接部件故障接受了翻修手术。此外，还分析了在另一所医院接受初次手术的 2 例患者，原因是连接机制故障。
7 例患者均行初次 TEA，初次 TEA 的平均年龄为 48 岁（范围，27-62 岁）。2 例患者为创伤后关节炎，3 例患者为类风湿关节炎，2 例患者为粉碎性肱骨远端骨折。初次 TEA 与连接部件故障的翻修 TEA 之间的平均时间为 13.6 年。根据术前影像学检查，诊断为 3 例衬套磨损和 4 例锁定销分离。肘关节疼痛和肿胀是最常见的临床症状。3 例衬套磨损病例均出现严重的骨溶解、假体周围骨折和柄松动。4 例锁定销分离病例中，2 例患者的男性锁定销指骨断裂。在翻修手术中，同时更换了锁定销和衬套。在本研究中，没有患者在连接部件故障的翻修手术后需要进行额外的手术。
连接部件故障后可能会出现骨溶解、部件松动、假体周围骨折。患者应定期进行影像学随访，包括短期和长期随访。早期诊断和干预，更换连接部件，可以防止广泛的翻修手术。
