title: Medium-term clinical results of a linked total elbow replacement system.
abstract: Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan-Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.
authors.affiliation: Mornington Orthopaedics, Beleura Private Hospital, 925 Nepean Highway, Mornington, Victoria, 3931, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Large
authors.affiliation: Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK.
authors.forename: A
authors.initials: A
authors.lastname: Tambe
authors.affiliation: Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cresswell
authors.affiliation: Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Espag
authors.affiliation: Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK.
authors.forename: D I
authors.initials: DI
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000503:physiopathology / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Discovery; Elbow Arthroplasty; Humeral Lucency; Obesity Infection; Semi-Constrained; joint replacement