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Failure of the linkage mechanism in a semi-constrained total elbow arthroplasty is a rare and unpredictable event: a review of seven cases

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan

    Po-An Chen, Alvin Chao-Yu Chen & Chun-Ying Cheng

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  1. Po-An Chen
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  2. Alvin Chao-Yu Chen
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  3. Chun-Ying Cheng
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by PAChen, ACYChen, and CYCheng. The first draft of the manuscript was written by PAChen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chun-Ying Cheng.

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Ethics approval and consent to participate

The study was approved by Chang Gung Medical Foundation Institutional Review Board: IRB No.: 202201581B0. For this type of study formal consent is not required. The IRB approves the waiver of the participants’ consent.

Competing interests

The authors declare no competing interests.

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Chen, PA., Chen, A.CY. & Cheng, CY. Failure of the linkage mechanism in a semi-constrained total elbow arthroplasty is a rare and unpredictable event: a review of seven cases. International Orthopaedics (SICOT) 48, 537–545 (2024). https://doi.org/10.1007/s00264-023-06015-1

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  • DOI: https://doi.org/10.1007/s00264-023-06015-1

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