RESEARCH - Souter arthroplasty for elbows with severe destruction

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Clin Orthop. 2004 Apr(421):126-33.

Souter arthroplasty for elbows with severe destruction.

Ikavalko M, Belt EA, Kautiainen H, Lehto MU.

Rheumatism Foundation Hospital, Heinola, Finland.

mikko.ikavalko@...

One hundred fifty-eight primary Souter elbow arthroplasties were done on

134 patients (121 women) with severe joint destruction (Larsen Grade 5)

or large bone defects or both. Joint replacement operations were done at

our institution from 1985-1997. The study group comprised 156 joints in

132 patients with rheumatoid arthritis or other variants of chronic

inflammatory joint disease, one in a patient with osteoarthritis, and

one patient with posttraumatic arthrosis. The mean age of the patients

at the time of surgery was 57 years (range, 26-81 years) and the mean

disease duration was 27 years (tinge, 2-70 years). Radiographically,

severe bone defects were detected in 100 humeri and 134 ulnas. Retentive

(snap-fit) ulnar components were implanted in 110 joints, and bone

grafts were used on 26 humeri and 14 ulnas. Major complications led to

five early and 16 late reoperations in 19 patients. Four reoperations

were done because of dislocation and eight because of aseptic loosening.

One reoperation was done because of early infection and five were done

because of late infection. One patient had reoperation because of

superficial infection in the bursa olecrani and one triceps tendon

rupture also was repaired. One patient had wound repair because of

marginal necrosis. In the survival analysis, the cumulative success rate

without revision for aseptic loosening at 5 years followup was 97%.

Despite the demanding nature of these arthroplasties, the primary

results are encouraging. Technically, it is possible to do elbow

replacement, even on elbows where the humeral condyles or olecranon or

both are missing, if there is sufficient bone left on the diaphyseal

areas for primary stem fixation. However, in these extreme cases, the

poor general condition of the patient or the difficult soft tissue

problems in the elbow region may prove to be a contraindication for

joint replacement.

PMID: 15123937

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