Long-term results of the iBP elbow prosthesis: beware of destructive metallosis!

Abstract

Background The aim of this study was to review the long-term results of the instrumented Bone Preserving (iBP) elbow prosthesis. Methods Thirty-one patients (10 M, 21F, 28-77 year) were retrospectively evaluated using the Oxford Elbow Score (OES), Disabilities of Arm, Shoulder and Hand Outcome Measure (DASH), Mayo Elbow Performance (MEPS), physical examination and standard radiographs. Kaplan-Meier survival analysis was used. Results Thirty-seven primary iBPs have been placed in 31 patients between 2000 and 2007. Six patients (8 prostheses) had died, 10 elbows had been revised and three patients (4 prostheses) were lost to follow-up. Fourteen patients (15 prostheses) were available for follow-up. The main indication for surgery was rheumatoid arthritis. Mean follow-up was 11 years (8–15). Kaplan-Meier survival analysis showed a survival of 81% at 10 years after surgery. Main reason for revision was particle disease and loosening due to instability and malalignment. Eleven of 14 patients were satisfied, although radiographs showed radiolucencies in 11 patients. Conclusion The iBP elbow prosthesis gives a survival rate of 81% 10 years after surgery with a progressive decline beyond 10 years. However, many patients have radiolucencies. Discrepancy between clinical signs and radiological results warrants structural follow-up, to assure quality of bone stock in case revision surgery is indicated. The study was reviewed and approved by the Medical Ethical Committee of University Medical Center Groningen (METc2016/038). Level of evidence Level IV, Case series.

Mid-term results of the Latitude primary total elbow arthroplasty

“…Progression of radiolucent lines can lead to loosening of the prosthesis. We recognize the aspect of asymptomatic radiolucent lines following TEA as described earlier, 13,18 and we expected that a more anatomic design would provide better fixation and show fewer of these radiologic signs. Our series did show, however, that also after a TEA with the Latitude prosthesis, patients should be followed up for asymptomatic loosening.…”

“…Still, ulnar nerve neuropathy rates appear to vary in the literature, and it is unclear whether mobilizing the nerve affects the outcomes. 3,5,17,18,20,23,24 Our routine care therefore remains locating and releasing the ulnar nerve during TEA while leaving the nerve posteriorly if possible or transposing it anteriorly when needed because of tension and pressure.…”

“…They did not detect loosening of the prosthesis, which has been described frequently as a longterm complication after TEA. 10,13,18,21 However, they did see radiolucencies around the humeral, ulnar, and radial components (4%-6%). Cinats et al 5 published their results with the Latitude prosthesis in a study with a mean followup period of 4.7 years but did not report survival rates either.…”