Modes of Wear After Semiconstrained Total Elbow Arthroplasty

Goldberg, Steven H.; Urban, Robert M.; Jacobs, Joshua J.; King, Graham J. W.; O'Driscoll, Shawn W.; Cohen, Mark S.
March 2008
Journal of Bone & Joint Surgery, American Volume;Mar2008, Vol. 90-A Issue 3, p609
Academic Journal
Background: Osteolysis and aseptic loosening are increasingly recognized complications of total elbow arthroplasty. However, unlike the literature on total hip and knee arthroplasty, studies describing the mechanisms of these processes after total elbow arthroplasty are sparse. Methods: Semiconstrained total elbow arthroplasty components were retrieved from sixteen elbows (fourteen patients) at either revision surgery (at a mean of five years after implantation) for mechanical failure (fifteen elbows) or postmortem examination (one elbow). In all cases, the retrieved implant was the primary implant. The patterns of damage on these components were investigated with stereomicroscopy in correlation with clinical findings, serial radiographs, and histopathological observations. Results: All of the retrieved devices exhibited multiple modes of wear. Damage to the humeral and ulnar polyethylene bushings was nearly universal; twenty-seven of twenty-eight humeral bushings demonstrated asymmetrical thinning, while fifteen of sixteen ulnar bushings demonstrated elliptical plastic deformation. In addition, unintended metal-on-metal wear between bearing and nonbearing surfaces or between two nonbearing surfaces was commonly observed, typically in association with wear and deformation of the polyethylene bushings. Wear between the stem and the cement mantle was observed in most of the ulnar components. The histopathology of the periprosthetic tissues was similar in character to that observed in association with osteolysis and loosening of total hip and knee replacements, while analysis of the particulate debris revealed a preponderance of titanium alloy and polyethylene debris. Barium sulfate particles were also observed to a lesser extent. Conclusions: Multimodal wear in total elbow replacements can lead to osteolysis, aseptic loosening, and prosthetic and periprosthetic fracture necessitating revision surgery. Polyethylene wear and damage, as well as unintended metal-on-metal wear, contribute to the periprosthetic particulate burden, which is likely pathogenic in these processes.


Related Articles

  • The osteoclast--what's new? Athanasou, Nicolas; Athanasou, Nicolas A // Skeletal Radiology;Sep2011, Vol. 40 Issue 9, p1137 

    Bone resorption is required for skeletal modelling during bone growth and for mineral homeostasis and bone remodelling throughout life. Osteoclasts are multinucleated cells that are uniquely specialised to carry out this physiological bone resorption. As osteolysis is a feature of most diseases...

  • Use Of Mineral Trioxide Aggregate In Treatment Of Internal Resorption: A Case Report. Gupta, Swati // Indian Journal of Dental Sciences;Mar2013, Vol. 5 Issue 1, p082 

    Mineral trioxide aggregate (MTA) has shown potential as a repair material for internal resorption. This clinical case demonstrates that when MTA was used as a repair material for internal resorption, the tooth was well in function for 12 months. Both clinical and radiographic follow-up showed a...

  • Mandibular Bone Turnover During Calcium Deficiency in the Rat. MURRAY, E. J.; MESSER, H. H.; ALAMOUDI, N. // Journal of Dental Research;Sep1982, Vol. 61 Issue 9, p1107 

    Bone resorption and deposition during calcium deficiency were compared in the mandible, femur, and vertebrae. While resorption did not differ markedly among the three sites, mineral deposition was lowest in the mandible, leading to a greater net loss of mineral than from femur or vertebrae.

  • Lipopolysaccharide-induced bone resorption is increased in TNF type 2 receptor-deficient mice in vivo. Hiroaki Saito; Hitoyata Shimokawa; Kazuhiro Aoki; Keiichi Ohya // Journal of Bone & Mineral Metabolism;Sep2008, Vol. 26 Issue 5, p469 

    Abstract  The release of tumor necrosis factor (TNF)-α from macrophages upon stimulation of lipopolysaccharide (LPS) is a major etiological factor of inflammatory bone disease and elicits the effects through TNF receptors type 1 and 2. Given the importance of TNF-α...

  • Dissociation of Bone Resorption and Bone Formation in Adult Mice with a Non-Functional V-ATPase in Osteoclasts Leads to Increased Bone Strength. Henriksen, Kim; Flores, Carmen; Thomsen, Jesper S.; Brüel, Anne-Marie; Thudium, Christian S.; Neutzsky-Wulff, Anita V.; Langenbach, Geerling E. J.; Sims, Natalie; Askmyr, Maria; Martin, Thomas J.; Everts, Vincent; Karsdal, Morten A.; Richter, Johan // PLoS ONE;2011, Vol. 6 Issue 11, p1 

    Osteopetrosis caused by defective acid secretion by the osteoclast, is characterized by defective bone resorption, increased osteoclast numbers, while bone formation is normal or increased. In contrast the bones are of poor quality, despite this uncoupling of formation from resorption. To shed...

  • Alterations in osteoclast function and phenotype induced by different inhibitors of bone resorption - implications for osteoclast quality. Neutzsky-Wulff, Anita V.; Sørensen, Mette G.; Kocijancic, Dino; Leeming, Diana J.; Dziegiel, Morten H.; Karsdal, Morten A.; Henriksen, Kim // BMC Musculoskeletal Disorders;2010, Vol. 11, p109 

    Background: Normal osteoclasts resorb bone by secretion of acid and proteases. Recent studies of patients with loss of function mutations affecting either of these processes have indicated a divergence in osteoclastic phenotypes. These difference in osteoclast phenotypes may directly or...

  • bone resorption. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p116 

    An encyclopedia entry for "bone resorption" is presented. The term refers to the loss of bone tissue. It cites the association between bone resorption and the laying down of new bone tissue. Bone resorption, with increasing age, exceeds the formation of new bone, along with the gradual thinning...

  • Bone Balance within a Cortical BMU: Local Controls of Bone Resorption and Formation. Smith, David W.; Gardiner, Bruce S.; Dunstan, Colin // PLoS ONE;Jul2012, Vol. 7 Issue 7, p1 

    Maintaining bone volume during bone turnover by a BMU is known as bone balance. Balance is required to maintain structural integrity of the bone and is often dysregulated in disease. Consequently, understanding how a BMU controls bone balance is of considerable interest. This paper develops a...


    The alveolar bone healing occurs by regeneration by forming new tissue remodeling, and it was removed or located on the old bone resorption and replacement by new bone deposition. Minerals such as calcium and phosphorus are the main constituents of mineralized bone matrix, forming crystals of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics