Primary Souter-Strathclyde Total Elbow Prosthesis in Rheumatoid Arthritis

• Published in: Journal of bone and joint surgery. American volume 2004-03, Vol.86 (3), p.465-473
• Main Authors: van der Lugt, J.C.T, Geskus, R.B, Rozing, P.M
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - surgery; Arthroplasty, Replacement - adverse effects; Arthroplasty, Replacement - instrumentation; Arthroplasty, Replacement - methods; Biological and medical sciences; Biomechanical Phenomena; Diseases of the osteoarticular system; Elbow Joint; Female; Humans; Inflammatory joint diseases; Joint Prosthesis - adverse effects; Joint Prosthesis - standards; Male; Medical sciences; Middle Aged; Pain - diagnosis; Pain - etiology; Pain Measurement; Paresthesia - etiology; Pronation; Proportional Hazards Models; Prospective Studies; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections - etiology; Radiography; Range of Motion, Articular; Reoperation - statistics & numerical data; Supination; Survival Analysis; Treatment Outcome; Ulnar Neuropathies - etiology
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200403000-00002

BackgroundTotal elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis.MethodsBetween June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter.ResultsSix of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years.ConclusionsTotal elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.Level of EvidenceTherapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.