Biomechanical analysis of total elbow replacement with unlinked iBP prosthesis: An in vitro and finite element analysis

BackgroundNumerous models of elbow prostheses are being used and can be divided into two categories: one being a semi-constrained, linked type; and the other being non-constrained, unlinked type. Recent reports of National Elbow Arthroplasty Registers reveal no significant differences in the survival rates between linked and unlinked prosthesis brands, and the main cause appointed for revision for both types is loosening. Some previous biomechanical studies confirm the presence of abnormal bone stresses for the linked type, which can be associated with the risk of loosening. However for the unlinked type, biomechanical studies are not available that corroborate a loosening risk. It seems, that issue has not yet been fully answered and requires further analysis.MethodsCortex strains adjacent to the elbow joint were measured with strain gauges in synthetic humeri and ulnae, before and after replacement. To assess cancellous bone strains and cement stresses around the implant finite element models validated relative to measured strains were used.FindingsBone strains adjacent to the implant tip increased several times in the humerus and ulna. At the epiphyseal regions a generalised cancellous bone strain reduction was observed for both humerus and ulna relatively to the intact bones.InterpretationThe unlinked elbow prostheses can be associated with the risk of bone fatigue failure by overload, particularly in the ulna, and bone resorption by stress-shielding at the epiphyseal regions. The identical structural behaviour relative to linked prostheses associated with the same loosening risks corroborates the results of recent arthroplasty published register reports.