Background: The objective of the present study was to review the results of
primary total elbow arthroplasty with use of the Coonrad-Morrey prosthesis
. Two hypotheses were tested: (1) the results in patients with inflammatory
arthritis would be superior to those in patients with a traumatic or postt
raumatic condition, and (2) the isometric extensor torque after total elbow
arthroplasty would be significantly less than that of the contralateral el
bow.
Methods: Forty-seven consecutive patients (fifty-one elbows) had the operat
ion performed by one of three surgeons between November 1, 1989, and June 3
0, 1996. Thirty-six surviving patients (thirty-nine elbows) were available
for follow-up. The mean duration (and standard deviation) of follow-up was
50 +/- 11 months (range, twenty-four to ninety-seven months). The mean age
at the time of the operation was 64 +/- 11 years (range, twenty-seven to ei
ghty-seven years). Eighteen patients (twenty-one elbows) had inflammatory a
rthritis. Eighteen patients (eighteen elbows) had an acute fracture or post
tranmatic condition (posttraumatic osteoarthritis in eight, an acute fractu
re of the humerus in seven, nonunion of the distal aspect of the humerus in
two, and primary osteoarthritis in one). The patients were evaluated with
use of questionnaires (the Mayo elbow performance index, the Short Form-36
[SF-3S], and the Disabilities of the Arm, Shoulder and Hand [DASH] Question
naire); clinical examination by an orthopaedic surgeon who was not involved
with the preoperative, operative, postoperative, or follow-up care; radiog
raphs; and elbow strength-testing with an isokinetic dynamometer.
Results: The mean score (and standard deviation) on the Mayo elbow performa
nce index for the group that had inflammatory arthritis (90 +/- 11 points)
was significantly higher than that for the group with a traumatic or posttr
aumatic condition (78 +/- 18 points) at the time of the latest follow-up (p
< 0.05). In both groups, the mean extensor torque of the involved elbow wa
s significantly less than that of the contralateral elbow (p < 0.05). No si
gnificant difference between the groups was found with respect to the flexi
on-extension are of motion. Ten elbows (26 percent) had ulnar nerve dysfunc
tion (a transient deficit in six and a permanent deficit in four); nine (23
percent), an intraoperative fracture (of the humeral diaphysis in four, of
the ulnar diaphysis in four, and of the olecranon in one); three (8 percen
t), a periprosthetic infection; three, a triceps disruption; and one (3 per
cent), a revision because of a fracture of the ulnar component. There were
no other revisions. Of the thirty-four elbows with complete radiographic fo
llowup, twenty-three had no change in the bone-cement interface. Progressiv
e radiolucency was noted around the ulnar prosthesis in eight elbows, aroun
d the humeral prosthesis in one elbow, and around both components in two el
bows.
Conclusions: Patients who had a total elbow arthroplasty with use of a semi
constrained Coonrad-Morrey prosthesis were generally satisfied; the mean le
vel of patient satisfaction was 9.2 of a possible 10 points for those who h
ad inflammatory arthritis and 8.6 points for those who had a fracture or po
sttraumatic condition. The rates of complications involving the ulnar nerve
, intraoperative fracture, triceps disruption, deep infection, and peripros
thetic radiolucency are of concern.