TABLE II.
Clinical, Radiographic, and Magnetic Resonance Imaging Data on the Twenty-six Elbows
| Timmerman and Andrews Score* |
Elbow Range of Flexion-Extension (deg) |
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| Preop. |
At Follow-up |
After Revision |
Preop. |
Follow-up |
After Revision |
MRI at 9 to 12 Months† |
MRI at 24 Months or Before Revision† |
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| Case | Total | Pain | Overall | Total | Pain | Overall | Total | Pain | Overall | Flex. | Ext. | Flex. | Ext. | Flex. | Ext. | Osseous Union | Marrow | Congruity | Marrow | Congruity | Additional Surgery |
| 1 | 70 | 5 | P | (130) | (20) | F | 160 | 20 | G | 120 | −45 | (125) | (−30) | 135 | −25 | + | (A)‡ | (N)‡ | − | − | At 24 mo postop, removal of screw and shaving of osteoarthritis |
| 2 | 125 | 10 | F | 175 | 25 | G | 175 | 25 | 130 | −10 | 125 | −15 | 125 | −15 | + | (A)‡ | (N)‡ | − | − | ||
| 3 | 110 | 10 | P | 195 | 25 | E | 195 | 25 | 125 | −15 | 130 | 0 | 130 | 0 | + | N | N | N | N | ||
| 4 | 120 | 10 | F | 200 | 25 | E | 200 | 25 | 115 | 0 | 125 | 10 | 125 | 10 | + | A | N | N | N | ||
| 5 | 135 | 10 | F | 200 | 25 | E | 200 | 25 | 120 | 0 | 135 | 10 | 135 | 10 | + | A | A | − | − | ||
| 6 | 50 | 5 | P | 140 | 25 | F | 140 | 25 | 110 | −40 | 125 | −5 | 125 | −5 | + | (A)‡ | (A)‡ | N | A | ||
| 7 | 125 | 10 | F | 200 | 25 | E | 200 | 25 | 120 | −5 | 140 | 0 | 140 | 0 | + | A | N | N | N | ||
| 8 | 110 | 5 | P | (95) | (10) | P | 200 | 25 | E | 125 | −10 | (125) | (−30) | 135 | 5 | + | A | A | N | A | At 18 mo, removal of free body (partial) |
| 9 | 115 | 5 | P | 200 | 25 | E | 200 | 25 | 135 | −5 | 140 | 10 | 140 | 10 | + | A | N | − | − | ||
| 10 | 145 | 10 | F | (170) | (20) | G | 200 | 25 | E | 130 | −5 | (140) | (5) | 140 | 0 | + | A | N | N | A | At 21 mo, shaving of protruding cartilage |
| 11 | 145 | 10 | F | 200 | 25 | E | 200 | 25 | 145 | −5 | 135 | 0 | 135 | 0 | + | N | N | N | N | ||
| 12 | 120 | 5 | F | (170) | (20) | G | 200 | 25 | E | 130 | −5 | (130) | (0) | 135 | 15 | + | N | A | N | A | At 20 mo, shaving of protruding cartilage |
| 13 | 65 | 10 | P | 200 | 25 | E | 200 | 25 | 125 | −45 | 140 | 0 | 140 | 0 | + | A | N | N | N | ||
| 14 | 85 | 5 | P | (130) | (10) | F | 180 | 25 | E | 130 | −30 | (135) | (−20) | 130 | −5 | + | A | N | N | A | At 24 mo, removal of unstable cartilage tissue |
| 15 | 140 | 10 | F | 200 | 25 | E | 200 | 25 | 130 | 0 | 140 | 5 | 140 | 5 | + | N | N | N | N | ||
| 16 | 45 | 5 | P | 180 | 25 | E | 180 | 25 | 110 | −65 | 135 | −5 | 135 | −5 | + | N | N | N | A | ||
| 17 | 110 | 5 | P | 195 | 25 | E | 195 | 25 | 125 | −25 | 140 | −5 | 140 | −5 | + | N | N | N | N | ||
| 18 | 130 | 5 | F | 200 | 25 | E | 200 | 25 | 135 | −5 | 140 | 5 | 140 | 5 | + | A | A | A | A | ||
| 19 | 135 | 5 | F | 175 | 25 | G | 175 | 25 | 130 | −15 | 125 | −10 | 125 | −10 | + | N | N | N | N | ||
| 20 | 145 | 5 | F | 200 | 25 | E | 200 | 25 | 135 | 0 | 135 | 10 | 135 | 10 | + | A | N | N | N | ||
| 21 | 120 | 5 | F | 200 | 25 | E | 200 | 25 | 135 | −5 | 140 | 5 | 140 | 5 | + | N | N | N | N | ||
| 22 | 145 | 10 | F | 200 | 25 | E | 200 | 25 | 125 | −5 | 130 | 10 | 130 | 10 | + | N | N | N | N | ||
| 23 | 115 | 10 | P | 170 | 20 | G | 170 | 20 | 120 | −20 | 135 | −10 | 135 | −10 | + | A | N | A | A | ||
| 24 | 115 | 10 | P | 175 | 25 | G | 175 | 25 | 115 | −5 | 120 | −15 | 120 | −15 | + | A | A | N | A | ||
| 25 | 80 | 5 | P | 200 | 25 | E | 200 | 25 | 115 | −20 | 140 | 0 | 140 | 0 | + | A | N | N | N | ||
| 26 | 90 | 5 | P | 185 | 25 | E | 185 | 25 | 135 | −30 | 140 | −10 | 140 | −10 | + | N | N | N | N | ||
| Mean# | 111 | 7 | 180§ | 23 | 190§ | 25 | 126 | −16 | 133§ | −3§ | 134§ | −1§ | + | ||||||||
According to the criteria of Timmerman and Andrews26, an overall score of E indicated excellent (180-200); G, good (160-179); F, fair (120-159); and P, poor (<120). Final follow-up status of these patients was the status after revision surgery.
Marrow, or revascularization, was assessed with T1-weighted MRI scans, N indicates nearly normal marrow intensity, and A indicates abnormal low intensity. Congruity was assessed with T2-weighted short tau inversion recovery scans, with N indicating round spherical articular surface and A indicating abnormal contour such as protrusion or irregular articular surface.
MRI was performed at six months postoperatively in Cases 1, 2, and 6, as indicated by parentheses. Dates are shown in parentheses. MRI was performed for the other twenty-three patients at nine to twelve months postoperatively. MRI was performed a second time at approximately twenty-four months postoperatively or before revision surgery.
A significant increase was detected compared with the preoperative status (p < 0.05) for the Timmerman and Andrews total score at follow-up (p = 0.000009 [or 0.0000084]) and after revision (p = 0.000008 [or 0.0000083]) and for elbow flexion (p = 0.000141) and extension (p = 0.000377) at follow-up and after revision (p = 0.000041 and p = 0.000015, respectively).
The Timmerman and Andrews overall score was F for thirteen patients and P for thirteen preoperatively; E for sixteen, G for six, F for three, and P for one patient at the time of follow-up; and E for twenty, G for five, and F for one after revision. The average arc of motion of the elbow was 110° preoperatively, 131° at follow-up, and 133° after revision. All twenty-six patients had osseous union. At nine to twelve months, MRI demonstrated a total of ten elbows with normal findings and sixteen with abnormal findings for marrow and twenty elbows with normal findings and six with abnormal findings for congruity. At twenty-four months or before revision, twenty elbows had normal findings and two had abnormal findings for marrow and thirteen had normal findings and nine had abnormal findings for congruity. Imaging was not available for four elbows.