Physiological Loading of the Coonrad/Morrey, Nexel, and Discovery Elbow Systems: Evaluation by Finite Element Analysis.

Abstract

Wear of polyethylene bearings represents a limiting factor in the long-term success of total elbow prostheses. Bearing stress is 1 factor contributing to accelerated wear. Physiological loading of total elbow prostheses and implant design influence upon bearing stresses have not been well described. This study evaluates bearing stresses in 3 commercially available implant designs under loads associated with daily living. Motion tracking from a healthy volunteer helped establish a musculoskeletal model to simulate flexor and extensor muscle activation at 0°, 45°, and 90° of shoulder abduction with a 2.3-kg weight in hand-forces and moments were measured at the elbow. Resulting physiological joint reaction forces and moments were applied to finite element models of 3 total elbow bearing designs (Coonrad/Morrey, Nexel, and Discovery) to evaluate contact area and polyethylene stresses. Increasing shoulder abduction resulted in minimal changes to the elbow joint reaction force but greater joint moments. All implants showed greater peak stresses with increasing shoulder abduction-elbow varus. Discovery and Nexel achieved greater contact area (23% vs > 100%) and demonstrated up to 39% lower peak polyethylene stresses compared with the Coonrad/Morrey design. Shoulder abduction results in a varus moment at the elbow. Newer bearing designs (Nexel and Discovery) provide a combination of higher contact area, improved load sharing, reduced edge loading, and lower stresses through elbow range of motion when compared with a cylindrical hinge-bearing design (Coonrad/Morrey). Although the Coonrad/Morrey is a clinically successful prosthesis, our physiological loading model shows that Discovery and Nexel provide greater contact area, better load sharing and lower peak stresses. This may lead to a decrease in polyethylene wear rates and the eventual risks of osteolysis and aseptic loosening. Further studies are needed to determine how these findings translate clinically.