Purpose
To assess the association between cement mantle characteristics and early radiographic
loosening in total elbow arthroplasty (TEA). We aimed to determine whether shorter
mantle heights (<20 mm) were associated with loosening.
Methods
We reviewed primary TEAs from a single healthcare system from 2006 to 2020. TEAs complicated
by infection or performed for oncologic conditions were excluded. Initial postoperative
radiographs were reviewed to determine cement mantle and component characteristics
(mantle quality, mantle height, and component angulation). One-year postoperative
radiographs were reviewed to assess for implant loosening, and we compared demographics
and radiographic criteria for cases with and without early loosening. We noted whether
cases underwent subsequent revision for aseptic osteolysis.
Results
A total of 54 TEA cases were included. Forty percent of ulnar and 24% of humeral mantles
were classified as short (between 1 and 19 mm). According to the Morrey classification,
6 (11%) cases had an inadequate cement mantle Twenty-four (45%) cases had radiographic
evidence of loosening at 1 year. Of the cases with early loosening, 6 (25%) had initial
inadequate mantle quality. There were no inadequate mantles in the group without loosening.
There were no statistically significant differences in mantle heights for cases with
and without loosening at 1 year after surgery. Eight (33%) cases underwent revision
in the group with early loosening compared with 1 (3%) case without early loosening.
Conclusions
Inadequate cement mantle quality was associated with an increased risk of early aseptic
loosening after primary TEA. Cement mantles that extended past the tip of the prosthesis
were not associated with loosening. Considering the potential need for future revision
and morbidity of cement removal, surgeons should focus on mantle quality and carefully
plan mantle height because shorter heights may not be associated with early implant
failure.
Type of study/level of evidence
Prognostic II.
Key words
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Article Info
Publication History
Published online: October 07, 2022
Accepted:
July 29,
2022
Received:
February 4,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
