title: Total elbow arthroplasty: a prospective clinical outcome study of Discovery Elbow System with a 4-year mean follow-up.
abstract: BACKGROUND
  Total elbow arthroplasty (TEA) is increasingly used for the treatment of advanced elbow conditions to reduce pain and improve function. However, TEA is still associated with a higher complication rate than total hip and knee arthroplasty despite advances in the design and surgical techniques. This prospective clinical study reports the outcome of the Discovery Elbow System (Biomet, Warsaw IN, USA), which has been in clinical use in the United Kingdom since 2003.
  
  
  METHODS
  The study included a total of 100 Discovery Elbows (April 2003 to January 2010) with a minimum 2-year follow-up, including 75 primary and 25 revisions (60% women and 40% men; mean age, 62 years). Outcome was assessed by means of the Liverpool Elbow Score, pain experience, patient satisfaction, range of motion, and radiographic imaging.
  
  
  RESULTS
  The mean follow-up period was 48.5 months (range, 24-108 months). The Liverpool Elbow Score improved from 3.79 to 6.36 (P < .001). The percentage of pain-free patients was substantially increased from 7% preoperatively to 64% at the final follow-up. The patient satisfaction rate was over 90%. The flexion-extension arc and pronation-supination arc increased from 72° to 93° and from 86° to 111°, respectively (P < .001). Major postoperative complications included deep infection (2%), progressive aseptic loosening requiring revision (primary, 5%; revision 12%), persistent ulnar neuropathy (3%), and periprosthetic fracture (primary, 6.8%; revision, 8%).
  
  
  CONCLUSIONS
  The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. Long-term results are required to assess the survivorship of this system.
authors.affiliation: School of Health Sciences, Liverpool Hope University, Liverpool, UK.
authors.forename: Omid
authors.initials: O
authors.lastname: Alizadehkhaiyat
authors.affiliation: Upper Limb Unit, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Mandhari
authors.affiliation: St. Luke's Hospital, Thessaloniki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Sinopidis
authors.affiliation: Musculoskeletal Science Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Wood
authors.affiliation: Musculoskeletal Science Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. Electronic address: s.p.frostick@liverpool.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Frostick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000295:instrumentation*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Discovery Elbow; Total elbow arthroplasty; clinical outcome; elbow prostheses