RESEARCH - Outcomes of total elbow arthroplasty for RA: comparative study of three implants

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J Bone Joint Surg Am. 2005 Nov;87(11):2439-48.

Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative

study of three implants.

Little CP, Graham AJ, Karatzas G, Woods DA, Carr AJ.

Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre,

Windmill Road, Headington, Oxford OX2 7BD, England.

christopher.little@...

BACKGROUND: As the English-language literature on prosthetic elbow

arthroplasty contains only two comparative studies of implants in

contemporary use, to our knowledge, comparisons of prosthetic performance is

difficult. An improved knowledge of comparative outcomes would be valuable

in guiding implant selection. METHODS: We identified three groups of

consecutive patients who had undergone prosthetic elbow arthroplasty with

the Souter-Strathclyde, Kudo, or Coonrad-Morrey implant for the treatment of

rheumatoid arthritis. There were thirty-three elbows in each group. All

procedures were done by or under the supervision of one surgeon. Surviving

patients in whom the elbow had not been revised were followed for a mean of

sixty-one months after treatment with the Souter-Strathclyde implant,

sixty-seven months after treatment with the Kudo implant, and sixty-eight

months after treatment with the Coonrad-Morrey implant. Clinical function

was assessed on the basis of pain relief and the range of flexion.

Survivorship was assessed with use of a life-table method, with revision

surgery and radiographic signs of loosening as the end points. RESULTS: The

groups were comparable in terms of age, sex, and mean duration of follow-up.

All three implant procedures relieved pain. Sustained improvement in the

range of flexion was comparable among the three groups, with no implant

procedure dramatically changing the fixed flexion deformity and all three

improving maximum flexion. Revision surgery was needed because of infection,

dislocation, and aseptic loosening. Survival of the Coonrad-Morrey implant

was better than that of the other two implants. The five-year survival

rates, with revision and radiographic signs of loosening as the end points,

were 85% and 81% for the Souter-Strathclyde implant, 93% and 82% for the

Kudo implant, and 90% and 86% for the Coonrad-Morrey implant. While

radiographic evidence of loosening of the Coonrad-Morrey implants was less

common, we noted focal osteolysis adjacent to 16% of these ulnar components

and half of these cases progressed to frank loosening.

CONCLUSIONS: The clinical function of these implants was similar in terms of

pain relief and range of motion. We believe that component linkage with the

Coonrad-Morrey implant prevents dislocation without increasing the risk of

loosening.

PMID: 16264119

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16264119 & itool=iconabstr & query_hl=22 & itool=pubmed_DocSum

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