This study reports outcomes of 461 primary Coonrad-Morrey linked semiconstrained total elbow arthroplasties performed for rheumatoid arthritis at a single institution over three decades. It addresses the question of how long these implants actually last and which factors predict failure.
TEA for RA works well at 10 years, but the 20-year all-cause survivorship of 68% matters most when you are sitting across from a 55-year-old RA patient asking what to expect.
Know the three main failure modes in order of importance: deep infection (7.8% overall reoperation rate), ulnar component loosening (the dominant mechanical failure), and progressive polyethylene bushing wear (the driver of late failures beyond 15 years).
Two patient-level risk factors nearly double the revision hazard: male sex and concomitant traumatic pathology. These patients warrant more careful shared decision-making and closer long-term surveillance.
The PMMA-precoated ulnar surface finish story is a board-relevant cautionary tale: a single implant design change intended to improve performance caused a 4.5-fold increase in mechanical failure through cement debonding and osteolysis. Modern plasma spray coating resolved this — understanding why surface finish matters is directly testable.
Finally, the authors flag that today's RA patients are more active because of biologic DMARDs, meaning this historical cohort's outcomes may actually overestimate survivorship in contemporary practice.
This study reports outcomes of 461 primary Coonrad-Morrey linked semiconstrained total elbow arthroplasties performed for rheumatoid arthritis at a single institution over three decades. It addresses the question of how long these implants actually last and which factors predict failure.
TEA for RA works well at 10 years, but the 20-year all-cause survivorship of 68% matters most when you are sitting across from a 55-year-old RA patient asking what to expect.
Know the three main failure modes in order of importance: deep infection (7.8% overall reoperation rate), ulnar component loosening (the dominant mechanical failure), and progressive polyethylene bushing wear (the driver of late failures beyond 15 years).
Two patient-level risk factors nearly double the revision hazard: male sex and concomitant traumatic pathology. These patients warrant more careful shared decision-making and closer long-term surveillance.
The PMMA-precoated ulnar surface finish story is a board-relevant cautionary tale: a single implant design change intended to improve performance caused a 4.5-fold increase in mechanical failure through cement debonding and osteolysis. Modern plasma spray coating resolved this — understanding why surface finish matters is directly testable.
Finally, the authors flag that today's RA patients are more active because of biologic DMARDs, meaning this historical cohort's outcomes may actually overestimate survivorship in contemporary practice.