Question:My brother traveled all the way to Mayo Clinic for an elbow replacement. He fractured his elbow in a bad car accident several years. It never healed quite right so they took it out and gave him a new titanium elbow. Within six weeks, he had a second surgery to repair a broken implant. Isn't titanium strong enough for the elbow?
Answer:Implant fractures after a total elbow replacement (TER) are fairly uncommon. When they happen, there are usually reasons for it. For example, decreased bone density (bone loss) around the implant can be a factor. This is usually more common in older patients.
Scratches or notches on the surface of the implant can decrease the strength and life of the titanium. This factor is called notch sensitivity. New implant designs may help with this problem. A special coating on the surface of the implant may increase its strength and decrease its vulnerability to damage.
Sometimes patients don't follow their surgeon's advice. They lift too much weight too soon after the operation. The result can be a fracture of the implant. Patients in high-demand occupations such as a waitress, truck driver, or farmer are especially at risk.
Titanium alloy remains the material of choice for elbow prostheses. It is strong but has some give and its accepted by the body more easily than cobalt-based or stainless steel devices. With the new plasma spray coating on implants, implant fractures have decreased considerably.George S. Athwal, MD, FRCSC, and Bernard F. Morrey, MD. Revision Total Elbow Arthroplasty for Prosthetic Fractures. In The Journal of Bone and Joint Surgery. September 2006. Vol. 88-A. No. 9. Pp. 2017-2026.
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