Souter-Strathclyde total elbow arthroplasty in rheumatoid arthritis: medium-term results

We present the outcome of 47 Souter-Strathclyde replacements of the elbow with a mean follow-up of 82 months (12 to 129). The clinical results were assessed using a condition-specific outcome measure. The mean total score (maximum 100) before the operation was 47.21 and improved to 79.92 (p < 0.001). The mean pain score (maximum 50) improved from 21.41 to 46.70 (p < 0.001) and the mean functional component of the score (maximum 30) from 11.19 to 18.65 (p < 0.001). There was negligible change in the score for the range of movement although a significant improvement in mean flexion from 124 degrees to 136 degrees was noted (p < 0.001).Revision surgery was required in four patients, for dislocation, wound dehiscence and early infection in one, late infection in two and aseptic loosening in one. The cumulative survival was 75% at nine years for all causes of failure and 97% at ten years for aseptic loosening alone. Our study demonstrates the value of the Souter-Strathclyde total elbow arthroplasty in providing relief from pain and functional improvement in rheumatoid patients.     

类风湿性肘关节炎半限制型假体置换的临床应用初步报告

[目的]探讨半限制型全肘关节置换对类风湿性肘关节炎的疗效。[方法]对22例(28肘)类风湿性肘关节炎患者行半限制型全肘关节置换,Morrey分期:28肘中6肘为Ⅲ期,17肘为Ⅳ期,5肘为Ⅴ期。平均随访26(12~44)个月,手术前后用Mayo肘关节评分进行评估,观察手术后疗效及并发症,并对两者进行差别显著性检验。[结果]28肘全部成功进行关节置换,术后行功能锻炼6周后患者的平均Mayo肘关节评分从(31.6±29.2)上升至(82.1±24.3)。手术前后肘关节功能有明显显著性差别(P<0.01)。[结论]半限制型全肘关节置换是治疗类风湿性肘关节炎的一种有效方法,它可以迅速解除关节疼痛,恢复关节的稳定性,改善关节的活动,但必须严格把握其临床适应证。     

The Kudo total elbow arthroplasty in patients with rheumatoid arthritis

A Kudo total elbow arthroplasty (TEA) was performed in 36 elbows in 35 patients with rheumatoid arthritis. Of those 35, 4 died, 6 prostheses were revised, and 2 were lost to follow-up. Twenty-four elbows with a mean follow-up of 58 months were radiologically and clinically reviewed. Sixteen were scored as excellent by use of the Mayo score and Hospital for Special Surgery 2 score. The mean increase in active motion was 25 degrees. Two humeral and four ulnar radiologic loosenings were noted. Two early dislocations were successfully treated with closed reduction and cast immobilization, two patients used an elbow brace after the closed reduction, and one patient underwent a resection arthroplasty for instability and deep wound infection. Four aseptic loosenings, of which three had an intraoperative fracture at the index operation and one had instability, were revised. Despite initially excellent results, longer follow-up of TEA in rheumatoid patients demonstrated deterioration of the outcome and increased loosening.     

Kudo total elbow arthroplasty in patients with rheumatoid arthritis: a long-term follow-up study.

BACKGROUND: Improvements in the design of total elbow prostheses over the last two decades have led to better and more consistent results. The type-3 Kudo total elbow prosthesis was developed in 1980. The long-term results of use of this implant have not been reported. Because it is an unlinked prosthesis, it is not known whether preservation of the anterior oblique component of the ulnar collateral ligament at the time of implantation is important. METHODS: A type-3 Kudo total elbow arthroplasty with cement was performed in forty-seven patients (fifty elbows) with rheumatoid arthritis. Revision rates, clinical symptoms, postoperative complications, and radiographic changes were assessed eleven to sixteen years (mean, thirteen years) postoperatively. RESULTS: The overall survival rate of the prosthesis was 90% at sixteen years. The mean Mayo elbow performance scores were all poor (mean overall score, 43 points) initially. The overall score was substantially improved at both the intermediate follow-up examination (four to six years after the operation) and the late follow-up examination (eleven to sixteen years after the operation), to 81 and 77 points, respectively. The overall rate of radiolucency about the humeral component was 45% at the intermediate follow-up examination and 100% at the long-term follow-up examination. The rate of radiolucency about the ulnar component at the intermediate and late follow-up examinations was 4.3% and 8.9%, respectively. No great differences in results were found with preservation of the anterior oblique component of the ulnar collateral ligament. CONCLUSIONS: This long-term follow-up study showed acceptable results of the type-3 Kudo total elbow arthroplasty in patients with rheumatoid arthritis. Preservation of the ulnar collateral ligament does not seem to be necessary when performing this procedure.     

Total elbow arthroplasty in rheumatoid arthritis

Background and purpose Although total elbow arthroplasty (TEA) is a recognized procedure for the treatment of the painful arthritic elbow, the choice of implant is still obscure. We evaluated the survival of different TEA designs and factors associated with survival using data from a nationwide arthroplasty register.

Methods 1,457 primary TEAs for rheumatoid elbow destruction were performed during 1982 to 2006 in one hospital specialized in the treatment of rheumatoid arthritis (n = 776) and in 19 other hospitals (n = 681). The mean age of the patients was 59 years and 87% of the TEAs were performed in women. We selected different contemporary TEA designs, each used in more than 40 operations including the Souter-Strathclyde (n = 912), i.B.P./Kudo (n = 218), Coonrad-Morrey (n = 164), and NESimplavit/Norway (n = 63) to assess their individual survival rates. Kaplan-Meier analysis and the Cox regression model were used for survival analysis.

Results The most frequent reason for revision was aseptic loosening (47%). We found no differences in survival rates between different TEA designs. We did, however, find a 1.5-fold (95% CI: 1.1–2.1) elevated risk of revision in unspecialized hospitals as compared to the one hospital specialized in treatment of rheumatoid arthritis. In the Souter-Strathclyde subgroup, there was a reduced risk of revision (RR 0.6, p = 0.001) in TEAs implanted over 1994–2006 as compared to those implanted earlier (1982–1993). The 10-year survivorship for the whole TEA cohort was 83% (95% CI: 81–86), which agrees with earlier reports.

Interpretation The influence of implant choice on the survival of TEA is minor compared to hip and knee arthroplasties. Inferior survival rates of the TEAs performed in the unspecialized hospitals demonstrates the importance of proper indications, surgical technique, and postoperative follow-up, and endorses the need for centralization of these operations at specialized units.     

Kudo total elbow arthroplasty in rheumatoid arthritis. Clinical and radiological results

We have analysed the results of 28 total elbow replacements in 27 patients. The replacements were made using the Kudo unconstrained, unlinked, total elbow prosthesis. The elbows were all affected by rheumatoid arthritis. The follow-up time was from 3 to 7 years, with a mean follow-up of 58 months. Our results with this prosthesis in rheumatoid arthritis appear promising and only few complications were noticed. In one case, a radiological loosening of the ulnar component was observed at the 5-year visit but without any clinical symptoms and no operations were needed. In two other cases, an open reduction was performed within the first 3 months to correct a subluxation. A triceps tendon was re-inserted for a fourth patient 55 months postoperatively. In general, the range of motion became statistically significantly better with the prosthesis and there was also a high rate of relief of pain in patients in whom the elbow was severely affected by rheumatoid arthritis.     

Long-term results of unconstrained Roper-Tuke total elbow arthroplasty in patients with rheumatoid arthritis

We evaluated the long-term results of 12 unconstrained Roper-Tuke total elbow replacements that were performed in 12 patients with rheumatoid arthritis from 1983 to 1989. The mean follow-up period was 9.5 years (range 8 to 13 years). We used the Ewald elbow-scoring system to chart results. This showed that the scores for the 12 elbows had improved from an average preoperative score of 39 points (range 17 to 72 points) to an average postoperative score of 80 points (range 45 to 97 points). The greatest improvements were in terms of pain relief, function, and range of motion. Eight elbows were free, of pain by the end of follow-up. Average elbow flexion increased from 115° before operation to 140° after operation, and pronation and supination increased from 52° to 61° and 42° to 71°, respectively. Radiographs of the 12 elbows showed constant wear of the ulnar polyethylene with loosening of 2 ulnar components. Revision of the prosthesis was necessary in 2 elbows because of aseptic loosening. Complications included 1 subluxation, 1 supracondylar fracture, and 2 ulnar neuropathies. Despite some excellent clinical results with a follow-up of over 10 years, the authors no longer recommend the use of this kind of elbow prosthesis in patients with rheumatoid arthritis because of the high complication rate and the impossibility of adapting this implant in the event of bone loss. The authors propose a new classification of humeral bone loss that will allow for better planning of primary and revision total elbow arthroplasties.     

Capitellocondylar total elbow replacement for rheumatoid arthritis.

In all, 23 capitellocondylar total elbow replacements were performed in 18 patients with rheumatoid arthritis. Follow-up was for a mean (range) of 3 (1.5-5) years. Pain relief was achieved in all patients and the postoperative range of movement showed an improvement in all directions. No evidence of radiological loosening has been seen. Complications consisted of a transient ulnar nerve palsy in 15 elbows (65%) and a permanent ulnar nerve palsy in one elbow (4%). In two elbows there was delayed wound healing.     

The Stanmore total elbow replacement for rheumatoid arthritis

Between 1970 and 1982, 50 total elbow replacements were carried out for rheumatoid arthritis using the Stanmore prosthesis. A long-term follow-up of the 44 elbows available for review is presented. Thirty-four of these (77%) had good results, five were fair, and five were poor. The complications and limitations are discussed.     

Upper limb function improvement following total elbow arthroplasty in patients with rheumatoid arthritis

Thirty-one primary total elbow replacements were implanted in 25 patients with rheumatoid arthritis between 2000 and 2004 by a surgeon. Twenty-six implants were GSB III. Seven were Coonrad–Morrey prostheses. The mean age of the patients was 70 years (40–88); 18 women, 6 men. DASH scores were recorded pre-operatively and at their latest review. Patients were also assessed according to the Mayo elbow performance score post-operatively. Mean follow-up was 29 months (8–55). The mean improvement in DASH (disabilities of the arm, shoulder and hand) was 25 (+6 to −45). The mean Mayo score (Corectly is the Mayo Elbow Score, there is also a Mayo liver score and other scores prposed in this center) was 85 (15–100). One implant was removed following deep infection (3%). One implant has been revised secondary to ulnar component fracture. Our overall major complication rate was 7%.     

Results of the Souter-Strathclyde total elbow arthroplasty in patients with rheumatoid arthritis: A preliminary report

The results of 19 consecutive Souter-Strathclyde total elbow arthroplasties (Zimmer, London) in 17 patients with a mean follow-up time of 41 months are reported. Pain relief was achieved in all cases, with 13 elbows becoming entirely painfree. The mean range of flexion increased 24° and extension improved 8°, with upper limb function greatly improved. The complication rate was 32%, including three nerve palsies, of which two resolved completely, and three early postoperative dislocations. There were two cases of prosthetic loosening, one following revision surgery for a traumatic humeral fracture in the early postoperative period. The authors consider the overall functional results with the Souter-Strathclyde prosthesis to be satisfactory in this group of patients.