Effectiveness of Revision Following Linked vs. Unlinked Total Elbow Arthroplasty

Author(s): Levy JC, Loeb M, Chuinard C, Adams RA, Morrey BF

Source: J Shoulder Elbow Surg 18: 457-62, 2009.


This is a retrospective review of 352 linked and 151 unlinked prostheses inserted at the Mayo Clinic.  The purpose of the study was to evaluate the implications of linked vs. non-linked designs on the survivorship of revision surgery.

During the interval from 1972-1990, the authors inserted 352 linked and 151 unlinked total elbow prostheses.  Of these, 24% underwent revision during the subsequent follow-up.  Fifty-five (16%) were linked and 67 (44%) were unlinked.  Comparisons were made between revisions done after a failed primary link following a failed unlinked prosthesis.  The results demonstrate that the unlinked prostheses were more reliable when revised to a linked device than when revised to another non-linked device, with survivorship of 84% vs. 47%.  The initial survivorship was 56% at approximately 6 years for the unlinked prostheses and 84% at approximately 6 years for the linked prostheses.  The authors conclude that primary linked implants display significantly better long-term survivorship than did the unlinked designs.  In addition, unlinked designs were more reliably converted to a linked implant.

The significance of this article is that it continues to demonstrate that despite the theoretic advantages of non-linked total elbow arthroplasty implants, the linked or “semi-constrained” designs appear to have greater longevity and are the revision implant of choice.