Morrey Award 2024: If I replace these bushings, how long will they last? An analysis of 58 isolated Coonrad-Morrey bushing exchanges with 21-year average follow-up.

Background: Reports of bushing exchange (BE) with retention of all other components (isolated BE) after Coonrad-Morrey total elbow arthroplasty (TEA) are limited to small case series. The purpose of this study was to determine the survival of isolated BE after primary or revision TEA. Secondary aims were to determine the survival of the humeral and ulnar stems, the risk factors for failure, and the complications and outcomes after 1 or more BEs.

Methods: Our Total Joint Registry database was queried to identify all elbows that underwent revision of a primary or revision Coonrad-Morrey TEA between 1981 and 2021. After excluding reoperations for infection, cancer, or inadequate records, 43 patients with 58 isolated BEs with retention of both the humeral and ulnar components were included. The mean age at the time of the initial TEA was 51 ± 12 years and 63% were female. A single BE was performed in 31 patients, while 12 had a revision BE. The mean follow-up was 21 years (range, 7-35 years).

Results: The median time to the first isolated BE was significantly longer than the time to revision BE (11.0 vs. 7.6 years; P = .036). Following the first isolated BE, Kaplan-Meier survivorship free of revision BE was 95% at 2 years, 87% at 5 years, 78% at 10 years, and 60% at 15 and 20 years. A "triceps on" approach during the index TEA was a risk factor (hazard ratio [HR], 27.0) for requiring a revision BE. The survivorship free of any revision was 78% at 5 years, 63% at 10 years, and 49% at 15 and 20 years. A "triceps on" approach during the index TEA (HR, 5.4) and post-traumatic arthritis or osteoarthritis (HR, 2.8) were risk factors for any revision. The overall survival of the humeral and ulnar stems was 73% at 20 years following the index TEA. The overall revision (28%) and complication (19%) rates, Mayo Elbow Performance Score (85 points), pain (1.5 points), and arc of motion (110°) were similar for single and multiple BEs.

Conclusions: While isolated BE is a relatively rare procedure, it should be considered in patients with substantial bushing wear and stable implants. Patients may experience relatively high revision and complication rates following isolated BE, but more than half retain their bushings and implants at long-term follow-up. Surgical and patient factors may increase the risk of revision following isolated BE, but patients can expect good clinical outcomes.