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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References
- Functional outcome of semiconstrained total elbow arthroplasty.J Bone Joint Surg Am. 2000; 82: 1379-1386
- Semiconstrained total elbow arthroplasty for posttraumatic arthritis or deformities of the elbow: a prospective study.J Hand Surg Am. 2013; 38: 1377-1382
- Total elbow arthroplasty. A five-year experience at the Mayo Clinic.J Bone Joint Surg Am. 1981; 63: 1050-1063
- Total elbow arthroplasty.J Hand Surg Am. 2019; 44: 487-495
- Total elbow arthroplasty: a descriptive analysis of 170 patients from a United States integrated health care system.J Hand Surg Am. 2021; 46: 552-559
- Primary total elbow arthroplasty for distal humeral fractures in elderly patients: a nationwide analysis.J Shoulder Elbow Surg. 2016; 25: 1854-1860
- Cementation technique for elbow arthroplasty: an international survey.J Orthop. 2019; 16: 459-462
- Risk factors for reoperation after total elbow arthroplasty.J Shoulder Elbow Surg. 2017; 26: 824-829
- Use and outcome of 1,220 primary total elbow arthroplasties from the Australian Orthopaedic Association national joint arthroplasty replacement registry 2008-2018.Acta Orthop. 2019; 90: 511-516
- Why does total elbow arthroplasty fail today? A systematic review of recent literature.Arch Orthop Trauma Surg. 2017; 137: 761-769
- Modes of wear after semiconstrained total elbow arthroplasty.J Bone Joint Surg Am. 2008; 90: 609-619
- Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008.J Shoulder Elbow Surg. 2014; 23: 829-836
- Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases.Int Orthop. 2016; 40: 73-80
- Outcomes, complications, utilization trends, and risk factors for primary and revision total elbow replacement.J Shoulder Elbow Surg. 2016; 25: 1020-1026
- Obesity is associated with increased postoperative complications after total elbow arthroplasty.J Shoulder Elbow Surg. 2015; 24: 1594-1601
- Complication and revision rates following total elbow arthroplasty.J Hand Surg Am. 2011; 36: 68-73
- Total elbow arthroplasty: elbow biomechanics and failure.J Hand Surg Am. 2019; 44: 687-692
- Results of cementless total elbow arthroplasty using the Discovery elbow system at a mean follow-up of 61.8 months.J Shoulder Elbow Surg. 2017; 26: 1348-1354
- Optimizing the femoral component cement mantle in total hip arthroplasty.Orthopedics. 2005; 28: s867-s871
- The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results.J Bone Joint Surg Am. 1994; 76: 77-87
- Aseptic loosening after total hip arthroplasty. Incidence, clinical significance, and etiology.J Arthroplasty. 1986; 1: 99-107
- Pressurization and centralization enhance the quality and reproducibility of cement mantles.Clin Orthop Relat Res. 1998; 355: 77-89
- Current cementing techniques in hip hemi-arthroplasty.Injury. 2001; 32: 461-464
- The use of cement in hip arthroplasty: a contemporary perspective.J Am Acad Orthop Surg. 2020; 28: e586-e594
- Radiographic comparison of cementing techniques in total hip arthroplasty.J Arthroplasty. 1986; 1: 241-247
- Total hip arthroplasty.J Bone Joint Surg Am. 1978; 60: 306-313
- The effect of two different types of cement restrictors on the femoral cement mantle.Acta Orthop Belg. 2006; 72: 702-708
- Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015.J Shoulder Elbow Surg. 2010; 19: 1115-1120
- Radial nerve palsy after humeral revision in total elbow arthroplasty.J Shoulder Elbow Surg. 2011; 20: 199-205
- Thermal tissue damage caused by ultrasonic cement removal from the humerus.J Bone Joint Surg Am. 2005; 87: 583-591
- Humeral windows in revision total elbow arthroplasty.Shoulder Elbow. 2016; 8: 130-133
- Reimplantation of a total elbow prosthesis following resection arthroplasty for infection.J Bone Joint Surg Am. 2008; 90: 589-594
- Complications of total elbow arthroplasty.J Am Acad Orthop Surg. 2011; 19: 328-339
- Ulnar cortical window for removal of a well-fixed ulnar component in total elbow arthroplasty: surgical technique and case report.Tech Shoulder Elb Surg. 2020; 21: 10-14
- Bone cement.J Clin Orthop Trauma. 2013; 4: 157-163
- A critical analysis of alignment factors affecting functional outcome in total elbow arthroplasty.J Arthroplasty. 1986; 1: 169-173
- Systematic review of literature of cemented femoral components: what is the durability at minimum 20 years followup?.Clin Orthop Relat Res. 2015; 473: 563-571
- The effect of cement restrictors on the occlusion of the humeral canal: an in vitro comparative study of 2 devices.J Arthroplasty. 2000; 15: 113-119
- Advanced cement technique improves fixation in elbow arthroplasty.Clin Orthop Relat Res. 1997; 1: 150-156
- Total replacement for post-traumatic arthritis of the elbow.J Bone Joint Surg Br. 1991; 73: 607-612
- Total elbow arthroplasty: a systematic review.JBJS Rev. 2017; 5: e4
- Femoral cement grading in total hip arthroplasty.J Arthroplasty. 1998; 13: 396-401
- Loose-hinge total elbow arthroplasty. An experimental study of the effects of implant alignment on three-dimensional elbow kinematics.J Arthroplasty. 1995; 10: 670-678
- Reliability analysis of radiologic and intraoperative loosening in total elbow arthroplasty.J Shoulder Elbow Surg. 2021; 30: 2401-2405
Article info
Publication history
Published online: October 07, 2022
Accepted:
July 29,
2022
Received:
February 4,
2022
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
