Limited influence of prosthetic position on aseptic loosening of elbow replacements: 125 elbows followed for an average period of 5.6 years.
BACKGROUND
Aseptic loosening of elbow replacements, seen in long-term follow-up, remains a problem. In this study, we attempted to determine the influence of cementing technique, prosthetic position, different component sizes, use of a bone plug, and intraoperative fractures on the development and progression of radiolucent lines and aseptic loosening.


METHODS
We studied standard radiographs of 125 primary Souter-Strathclyde total elbow prostheses using the Wrightington method. Additionally, 104 preoperative radiographs were available for analysis. We used a Markow statistical model to detect relationships between all factors described above.


RESULTS
After a mean follow-up time of 5.5 (2-19) years, 21 (17%) prostheses had loosened radiographically (10-year survival: 65%). When the humeral component was tilted more medially or more anteriorly, we found development of radiolucent lines at the medial condyle and at the posterior side of the humeral component. However, the progression of these lines was not influenced by these positions. No other prognostic factors for radiolucent lines or aseptic loosening were found.


CONCLUSIONS
Despite the small number of elbows studied, the weak influence of prosthetic position on aseptic loosening gives more ground for a multifactorial cause for aseptic loosening of the Souter-Strathclyde total elbow prosthesis.
van der Lugt
Joris C T
JC
Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands. j.c.t.van der lugt@lumc.nl
Geskus
Ronald B
RB
Rozing
Piet M
PM
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D007595:Joint Prosthesis / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery; D011187:Posture; D011379:Prognosis; D011475:Prosthesis Failure; D011859:Radiography