Postoperative results and complications of total elbow arthroplasty in patients with rheumatoid arthritis: three types of nonconstrained arthroplasty

Postoperative results and complications of total elbow arthroplasty (TEA) conducted for rheumatoid arthritis (RA) patients at our institute were studied. Primary TEAs were performed in 72 patients. The mean follow-up period was 3.5 years. Three types of prostheses were implanted: JACE prosthesis in 34 elbows, STABLE prosthesis in 13 elbows, and KUDO prosthesis (type 5) in 32 elbows. The outcome was evaluated by the change in the range of motion and the Japanese Orthopaedic Association functional evaluation score for the elbow joint (JOA score). The arc of motion and the JOA score at discharge and at final examination significantly improved in patients with the three types of prosthesis. The loosening rates for the JACE, STABLE and KUDO prostheses were 15, 23, and 0%, respectively, although the follow-up periods were different. The loosening rate decreased to 2.5% when the humeral component was fixed with cement. Intraoperative fractures occurred in eight (10.1%) elbows and ulnar nerve palsy in six. Deep infection developed in three (4.8%) elbows and was treated by removing the prosthesis. Although there were considerable complications, the marked improvements in pain and function favor TEA in patients with rheumatoid elbow.     

Postoperative results and complications of total elbow arthroplasty in patients with rheumatoid arthritis: three types of nonconstrained arthroplasty

Abstract

Postoperative results and complications of total elbow arthroplasty (TEA) conducted for rheumatoid arthritis (RA) patients at our institute were studied. Primary TEAs were performed in 72 patients. The mean follow-up period was 3.5 years. Three types of prostheses were implanted: JACE prosthesis in 34 elbows, STABLE prosthesis in 13 elbows, and KUDO prosthesis (type 5) in 32 elbows. The outcome was evaluated by the change in the range of motion and the Japanese Orthopaedic Association functional evaluation score for the elbow joint (JOA score). The arc of motion and the JOA score at discharge and at final examination significantly improved in patients with the three types of prosthesis. The loosening rates for the JACE, STABLE and KUDO prostheses were 15, 23, and 0%, respectively, although the follow-up periods were different. The loosening rate decreased to 2.5% when the humeral component was fixed with cement. Intraoperative fractures occurred in eight (10.1%) elbows and ulnar nerve palsy in six. Deep infection developed in three (4.8%) elbows and was treated by removing the prosthesis. Although there were considerable complications, the marked improvements in pain and function favor TEA in patients with rheumatoid elbow.     

Limited extension after linked total elbow arthroplasty in patients with rheumatoid arthritis

Objective: Total elbow arthroplasty (TEA) has become an established procedure to relieve pain and to increase the range of motion of the destructed elbow in patients with rheumatoid arthritis (RA). However, some patients still have limited extension after TEA, and the causes of limited extension after TEA have yet to be elucidated.

Methods: To examine whether widening of the joint space can cause such limited extension, we retrospectively analyzed 55 cases of linked TEA in patients with RA. There were seven male and 40 female with a mean age of 63.8 years (range, 30–80 years) and a mean follow-up of 7.5?±?4.2 years (range, 2.5–15.6 years). The Mayo Elbow Performance Score (MEPS) and radiological measurements were recorded. Widening of the joint space was calculated by subtracting the length measured on postoperative radiograph from preoperative radiograph.

Results: MEPS and range of motion were significantly improved after surgery except for extension. The degree of extension was significantly correlated with radiological widening of the joint space in the limited extension group. Correlation analyses showed that postoperative limited extension was correlated with lower MEPS daily function.

Conclusions: Limited extension after linked TEA is partly derived from perioperative widening of the joint space and potentially limits daily function in patients with RA.     

Clinical and radiological results of non-cement impaction bone-graft method of total hip arthroplasty for rheumatoid arthritis

Abstract

We performed total hip arthroplasty using the non-cement impaction auto-bone-grafting method with the resected femoral head for acetabular protrusion that is not combined with the destruction of acetabular rim or dysplasia of the hip joint. Ten patients (eight women and two men) with rheumatoid arthritis who showed acetabular protrusion underwent total hip arthroplasty using this method. All patients were able to walk with full weight within 5 days after surgery. The short-term results of our cases were very good. The postoperative periods of the radiographic-bone incorporation of the grafting bone were 2 months after surgery in four joints, 3 months after surgery in four joints, and 4 months after surgery in three joints. There were no cases that showed any migration or radiolucency around the acetabular component at the time of follow-up. Our operative technique is simple and easy, and it is a useful method for the treatment of protrusion in patients with rheumatoid arthritis.     

Clinical and radiological results of non-cement impaction bone-graft method of total hip arthroplasty for rheumatoid arthritis

We performed total hip arthroplasty using the non-cement impaction auto-bone-grafting method with the resected femoral head for acetabular protrusion that is not combined with the destruction of acetabular rim or dysplasia of the hip joint. Ten patients (eight women and two men) with rheumatoid arthritis who showed acetabular protrusion underwent total hip arthroplasty using this method. All patients were able to walk with full weight within 5 days after surgery. The short-term results of our cases were very good. The postoperative periods of the radiographic-bone incorporation of the grafting bone were 2 months after surgery in four joints, 3 months after surgery in four joints, and 4 months after surgery in three joints. There were no cases that showed any migration or radiolucency around the acetabular component at the time of follow-up. Our operative technique is simple and easy, and it is a useful method for the treatment of protrusion in patients with rheumatoid arthritis.     

A new total elbow arthroplasty for rheumatoid arthritis

Abstract

We have followed up the results of total elbow arthroplasties on 36 elbows in 28 patients using a prosthesis newly designed in our department. The characteristics of this elbow joint (NR type) were: none constrained type, minimum bone resection and adapting each elbow joint size. The results were compared before and after operations on the basis of the Elbow Evaluation Sheet prepared by the Japanese Orthopaedic Association. The usefulness of the new prosthesis is evaluated and the problems involved are discussed. Seven years and 8 months on average (from 3 years 6 months to 13 year 9 months) after the operation, relief of pain and an increase in the flexion angle were particularly remarkable. As compared with the preoperative conditions, the activities of daily living of patients were improved, especially washing their faces, buttoning-up their shirts and eating food with greater ease. The most frequent complication was restriction to extension, which developed in 12 elbows (33%). Postoperative infection was seen in two joints of two patients (5.5%), fall out the ulnar component due to fracture of olecranon in one (2.8%) and dislocation of the elbow joint in another (2.8%). The survival rate of this elbow joint was 90% at an average 7 years and 8 months follow-up. This new elbow joint has good durability and is very useful in improving the function of the elbow joint destroyed by rheumatoid arthritis.     

A new total elbow arthroplasty for rheumatoid arthritis

We have followed up the results of total elbow arthroplasties on 36 elbows in 28 patients using a prosthesis newly designed in our department. The characteristics of this elbow joint (NR type) were: none constrained type, minimum bone resection and adapting each elbow joint size. The results were compared before and after operations on the basis of the Elbow Evaluation Sheet prepared by the Japanese Orthopaedic Association. The usefulness of the new prosthesis is evaluated and the problems involved are discussed. Seven years and 8 months on average (from 3 years 6 months to 13 year 9 months) after the operation, relief of pain and an increase in the flexion angle were particularly remarkable. As compared with the preoperative conditions, the activities of daily living of patients were improved, especially washing their faces, buttoning-up their shirts and eating food with greater ease. The most frequent complication was restriction to extension, which developed in 12 elbows (33%). Postoperative infection was seen in two joints of two patients (5.5%), fall out the ulnar component due to fracture of olecranon in one (2.8%) and dislocation of the elbow joint in another (2.8%). The survival rate of this elbow joint was 90% at an average 7 years and 8 months follow-up. This new elbow joint has good durability and is very useful in improving the function of the elbow joint destroyed by rheumatoid arthritis.     

Total elbow joint arthroplasty in patients with rheumatoid arthritis

As a result of better patient selection, implant design, and surgical technique, the long-term results of total elbow arthroplasty in patients with rheumatoid arthritis has improved significantly over the past 10 years. The semiconstrained hinge implant is used in the presence of severe bone and ligament destruction. The non-constrained surface replacement requires intact bone and ligamentous supports. Best results are obtained if surgery is undertaken before severe soft tissue contractures, muscle atrophy, and neurologic disability of the involved extremity develop.     

Minimum 10-year results of cementless total hip arthroplasty in patients with rheumatoid arthritis

Objectives: To retrospectively evaluate the long-term results of cementless total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) and postoperative patient mortality after THA.

Methods: This study included 191 hips in 149 RA patients who underwent cementless THA between 1998 and 2005. Mean age at surgery was 54.2 years, and mean follow-up was 12.6 years. Implant and patient survivorships were determined using the Kaplan–Meier method, and the associated influencing factors were determined.

Results: Implant survivals at 17 years were 99.5% for stems, 93.9% for cups, and 90.8% for liners. Among the liners used, THAs with highly cross-linked polyethylene showed better survivals compared with those with conventional polyethylene and alumina-bearing surface (93.4%, 90.9%, and 52.2%, respectively). A total of 64 deaths occurred; 45 patients died within 10 years and 19 patients died between 10 and 17 years. Malignancy (25.0%) was the leading cause of death, followed by pneumonia (20.8%) and sepsis (20.8%). The patient survival rate was 36.9% at 17 years after THA. Multivariate analysis exhibited that older age at operation and greater dose of concomitant corticosteroid resulted in shorter patient survivals.

Conclusions: Cementless THA worked well in patients with RA. Mortality remained high among RA patients who needed THA.     

Outcome of shortened extra-small ulnar component in linked total elbow arthroplasty for patients with rheumatoid arthritis*

Objective. We compared the clinical and radiological results of the 3-inch shortened ulnar stem of the extra-small component of Coonrad–Morrey prosthesis with those of the other ulnar components for patients with rheumatoid arthritis (RA).

Methods. A total of 33 Coonrad–Morrey total elbow arthroplasty (TEA) procedures were performed. Of these, 27 elbows of 25 patients with RA underwent primary TEA. The results of the clinical and radiological findings were compared between groups of patients receiving the shortened ulnar stem of extra-small components (shortened group) and of those receiving the components of the other sizes (control group).

Results. The mean follow-up was 6.2 ± 2.8 years in the shortened group and 7.2 ± 2.5 years in the control group. The Mayo elbow performance score and range of motion results were substantially improved after the operation for both groups. We encountered several peri- and postoperative complications, but no significant differences in clinical results were found between the groups. The control group had three cases of osteolysis around the implant, while the shortened group did not.

Conclusions. TEA with a shortened ulnar implant of the extra-small size of the Coonrad–Morrey prosthesis gave satisfactory mid-term results among patients with RA.     

Clinical and radiological effects of anakinra in patients with rheumatoid arthritis

Interleukin-1 (IL-1) is a proinflammatory cytokine that plays a pivotal role in the pathophysiology of rheumatoid arthritis (RA). Inhibiting the activities of IL-1 at the receptor level with the recombinant human IL-1 receptor antagonist anakinra (Kineret; Amgen Inc., Thousand Oaks, CA) is a new therapeutic option for the management of patients with RA. Randomized, placebo-controlled trials have demonstrated that anakinra, alone and in combination with methotrexate, improves the signs and symptoms of RA. Anakinra also produces improvements in patient functionality and health-related quality of life, as measured by the Health Assessment Questionnaire and the Nottingham Health Profile, and reduces the number of productivity days missed due to illness. Furthermore, an initial study indicates that anakinra retards the progression of radiographic joint damage. Such clinical findings suggest that anakinra is an important addition to the rheumatology treatment armamentarium.     

Treatment of infected total knee arthroplasty in patients with rheumatoid arthritis

Abstract

The primary aim of treating infected knee joints after total knee arthroplasty is to eradicate the infection, but this is difficult to achieve. We reviewed the treatment of infections that occurred after total knee arthroplasty in patients with rheumatoid arthritis. The subjects were 14 patients with rheumatoid arthritis (3 men, 11 women; ages 38–81 years) who had 14 infected knee joints. The outcome was preservation of the implant in two cases, revision arthroplasty in six cases, arthrodesis in three cases, resection arthroplasty in one case, amputation in one case, and death in one case. If there is no loosening, preservation of the implant should be attempted. If preservation is impossible, revision arthroplasty is the next best option considering the effect on daily activities in patients with the disease affecting multiple joints.     

Treatment of infected total knee arthroplasty in patients with rheumatoid arthritis

The primary aim of treating infected knee joints after total knee arthroplasty is to eradicate the infection, but this is difficult to achieve. We reviewed the treatment of infections that occurred after total knee arthroplasty in patients with rheumatoid arthritis. The subjects were 14 patients with rheumatoid arthritis (3 men, 11 women; ages 38–81 years) who had 14 infected knee joints. The outcome was preservation of the implant in two cases, revision arthroplasty in six cases, arthrodesis in three cases, resection arthroplasty in one case, amputation in one case, and death in one case. If there is no loosening, preservation of the implant should be attempted. If preservation is impossible, revision arthroplasty is the next best option considering the effect on daily activities in patients with the disease affecting multiple joints.     

Clinical results of total knee arthroplasty using Kinematic type in patients with rheumatoid arthritis under the age of 50 years

We reviewed 24 total knee arthroplasties using Kinematic type (anteriorly joined type or posterior cruciate retention type) in 18 rheumatoid patients who were under the age of 50 years. Thirteen knees with Kinematic type total knee arthroplasty in 10 rheumatoid patients who were over 70 years of age were also reviewed. Using rheumatoid arthritic knee rating score of J.O.A. (Japan Orthopedic Association), the clinical results of young patients were evaluated and were compared with those of elderly patients. The average total score of young patients and that of older patients was almost equally increased after arthroplasty. Postoperatively in older patients, pain score was elevated more remarkably than in young patients. However, increase in score of quadriceps muscle strength, walking ability and climbing stairs ability were less in older patients than that in young patients. Range of motion was not improved in both young and older patients. However, flexion contracture was improved remarkably in both groups.     

Biaxial total wrist arthroplasty in rheumatoid arthritis. Satisfactory functional results

We reviewed 16 uncemented biaxial total wrist arthroplasties (TWA) in 14 patients with rheumatoid or juvenile arthritis. The mean follow-up was 25 months (range 5–60). According to the Hospital for Special Surgery scoring system (HSS), good-to-excellent results were accomplished in 69%, moderate in 19%, and poor in 12%. The mean pain score was 0.4 on a visual analog scale from 0–10 (0=no pain). The Wrightington activities of daily life assessment chart showed a 63% improvement, and we found a threefold increase in range of motion at follow-up. Four TWAs showed early dislocation, one of which was revised. Biaxial TWA yields good short-term results in rheumatoid patients, although instability is a frequent complication.     

HLA-DRB1 haplotype did not affect the medium-term results of total knee arthroplasty in patients with rheumatoid arthritis

This study investigated whether the HLA-DRB1 susceptible allele (SA) genotype is predictive for total knee arthroplasty (TKA) failure in patients with rheumatoid arthritis (RA). The results of 49 TKAs (30 RA patients) with an average follow-up of 7.9 years (range 5–15 years) were analyzed using a 12-item questionnaire and the Knee Society system. HLA-DRB1 alleles were used to estimate the severity of RA and divide the patients into three categories depending upon the gene dose of SA (SA+/+, SA+/–, and SA–/–). For all three categories, the 12-item questionnaire had significantly improved postoperatively, but without significant difference. We divided the 12 items of the questionnaire into two groups: knee-relevant parameters and general parameters. Patients in all three groups improved similarly in knee-relevant parameters. In contrast, those homozygous for SA (SA+/+) benefited less in general parameters. The average radiolucency score was 1.87mm, with no difference being detected among the three groups. The HLA-DRB1 genotype did not affect the survival of the knee implants. Overall, patients without the RA-associated HLA gene benefited most from TKA as they improved not only in knee function, but also in parameters of general functional status.     

Longterm outcome of total joint arthroplasty in nonambulatory patients with rheumatoid arthritis.

OBJECTIVE: To assess the outcome of minimum 10 year followup of total joint arthroplasty (TJA) in nonambulatory patients with rheumatoid arthritis (RA). METHODS: TJA was performed in 40 nonambulatory patients with RA who satisfied the following criteria: (1) strong motivation; (2) good relationship with our medical staff; (3) no marked cervical cord lesion: (4) absence of severe systemic complications. These included 38 women and 2 men whose average age at the initiation of TJA was 58.8 years. The duration of time between loss of walking ability and surgery was 2 months to 5 years. Average hospitalization time was 4.5 months. Followup after the last surgery was 10 to 18 years. RESULTS: One year after the last surgery, 28 of the 40 patients could walk outdoors again, 11 indoors, and one was still unable to walk. By 5 years after surgery, 9 patients had died of diseases unrelated to surgery. Of the remaining 31 patients, 19 could walk outdoors, 10 indoors, and 2 could not walk. Deterioration of walking was observed in 13 patients (41.9%) compared with one year after surgery. By 10 years after surgery, 32 patients had died of diseases unrelated to surgery, 4 could walk outdoors, 4 indoors. Of these, 4 patients (50%) had worsened in walking ability compared with one or 5 years after surgery. Major complications of TJA were observed in 12 patients. These were femoral neck fractures in 3, supracondylar femoral fractures in 3, loosening of the acetabulum socket in 4, loosening of the femoral hip prosthesis in 2. CONCLUSION: TJA should be a useful treatment for restoration of walking in nonambulatory patients with RA. However, even after TJA, walking ability deteriorated in about half of the patients as the duration of followup observations exceeded 5 years.     

Long-term clinical and radiographic results of cementless total hip arthroplasty for patients with rheumatoid arthritis: minimal 10-year follow-up

Abstract

Objectives. The aim of this study was to clarify the long-term clinical and radiographic results of cementless total hip arthroplasty (THA) for patients with rheumatoid arthritis (RA).

Methods. Twenty-eight total hip arthroplasties in 24 patients with a diagnosis of RA were performed from October 1992 to October 1996. All components were titanium alloy with a circumferential porous coating. Six patients (six hips) died before the 10-year follow-up, and one patient (one hip) was lost to follow-up, leaving 21 joints of 17 patients for review at a minimum 10-year follow-up after surgery. There were 3 men and 14 women with an average age of 55.0 years. The average duration of RA at the time of the operation was 12.6 years, and the average follow-up period was 12.2 years. We evaluated the Japanese Orthopaedic Association (JOA) hip scores, radiographic changes and survivor rates of components.

Results. Compared with the preoperative JOA hip scores, there was significant improvement in the postoperative scores. Spot welds consistent with bone ingrowth were identified in 95.0% of the femoral components. No femoral components showed radiographic loosening or required revision for aseptic loosening, but two acetabular revisions were performed because of aseptic loosening. The 14-year survivor rates of the stem and cup with the end point of loosening were 100% and 88.2%, respectively.

Conclusions. Cementless THA with this component design in patients with RA appears to be a promising treatment.