Effectiveness of revision following linked versus unlinked total elbow arthroplasty

PURPOSE: The purpose of this study is to specifically evaluate the implications of unlinked and linked designs on the survivorship of revision surgery. METHODS: Between 1972 and 1990, 352 linked and 151 unlinked prostheses were inserted at our institution. One-hundred and twenty-two elbows (24%) underwent subsequent revision: 55 linked (16%) and 67 unlinked (44%). Survivorship of the initial and revision total elbow replacement was calculated using a Kaplan-Meier analysis. Comparisons were made between revisions done after a failed primary linked or unlinked designs. The unlinked revised to a linked device was more reliable than when revised to another unlinked device: 1 year survival 84% compared to 47%. RESULTS: Initial survival was 56% at 367 months and 84% at 371 months for the unlinked and linked cohorts, respectively (P < .001). A second revision was required in 12 of the 35 elbows (30%) in the linked cohort and 14 of the 50 elbows (28%) in the unlinked. CONCLUSIONS: At our institution, primary linked implants display significantly better long-term survivorship (P < .001) than did the unlinked designs. Unlinked designs are most reliably converted to a linked implant.