Effectiveness of revision following linked versus unlinked total elbow arthroplasty

Purpose The purpose of this study is to specifically evaluate the implications of unlinked and linked designs on the survivorship of revision surgery. Methods Between 1972 and 1990, 352 linked and 151 unlinked prostheses were inserted at our institution. One-hundred and twenty-two elbows (24%) under...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2009-05, Vol.18 (3), p.457-462
Main Authors: Levy, Jonathan C., MD, Loeb, Michael, MD, Chuinard, Christopher, MD, Adams, Robert A., PA-C, Morrey, Bernard F., MD
Format: Article
Language:English
Subjects:
Arthroplasty, Replacement - adverse effects
Arthroplasty, Replacement - methods
Biological and medical sciences
Cohort Studies
Diseases of the osteoarticular system
Elbow Joint - surgery
Female
Follow-Up Studies
Humans
Joint Instability - prevention & control
Joint Prosthesis
Kaplan-Meier Estimate
Male
Medical sciences
Orthopedic surgery
Orthopedics
Probability
Prosthesis Design
Prosthesis Failure
Range of Motion, Articular - physiology
Reoperation - methods
Retrospective Studies
Risk Assessment
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
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Summary:Purpose The purpose of this study is to specifically evaluate the implications of unlinked and linked designs on the survivorship of revision surgery. Methods Between 1972 and 1990, 352 linked and 151 unlinked prostheses were inserted at our institution. One-hundred and twenty-two elbows (24%) underwent subsequent revision: 55 linked (16%) and 67 unlinked (44%). Survivorship of the initial and revision total elbow replacement was calculated using a Kaplan-Meier analysis. Comparisons were made between revisions done after a failed primary linked or unlinked designs. The unlinked revised to a linked device was more reliable than when revised to another unlinked device: 1 year survival 84% compared to 47%. Results Initial survival was 56% at 367 months and 84% at 371 months for the unlinked and linked cohorts, respectively ( P < .001). A second revision was required in 12 of the 35 elbows (30%) in the linked cohort and 14 of the 50 elbows (28%) in the unlinked. Conclusions At our institution, primary linked implants display significantly better long-term survivorship ( P < .001) than did the unlinked designs. Unlinked designs are most reliably converted to a linked implant. Level of evidence Level 3; Treatment study, retrospective case-control study.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2008.11.016