Failure of Semiconstrained Elbow Arthroplasty: Aseptic Loosening and Revision

Abstract

In the past decade, the applications of elbow arthroplasty have been expanded to the treatment of degenerative and post-traumatic conditions. The most common complications include aseptic loosening, infection, periprosthetic fracture and triceps insufficiency, implant instability, and ulnar neuropathy. The incidence of clinically significant aseptic loosening is 7–15%, but the rate of periprosthetic radiolucency without clinical symptoms is even higher. Aseptic loosening is the most frequent cause of long-term implant failure. Although component loosening may be related to several causes, the most common risk factors include mechanical failure, inadequate surgical technique, and patient non-compliance. The indication for surgical revision is based on the assessment of elbow function, pain-limited activities of daily living, and pain at rest. The physical examination includes the signs that suggest infection. Radiographic evaluation assists in staging and depicts the main features of implant loosening. Plain anteroposterior and lateral radiographs are usually obtained, and computed tomography may be useful to gauge the extent of stem loosening and bone loss. Surgical revision is usually indicated in patients with polyethylene wear or symptomatic loosening of linked semiconstrained prostheses. It should also be considered in patients with progressive radiolucency or extensive osteolysis even in the absence of symptoms. Preoperative planning requires imaging data to gauge bone stock status and quality, osteolysis, component loosening, and implant status. The most common indications for reoperation following aseptic loosening are bushing replacement and reimplantation with or without bone augmentation.

In conclusion, aseptic loosening of total elbow arthroplasty may result from several causes, and revisions are technically demanding procedures.