The Journal of Bone and Joint Surgery, Vol 72, Issue 3 355-362, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Total elbow arthroplasty with a non-constrained surface-replacement prosthesis in patients who have rheumatoid arthritis. A long-term follow-up study
H Kudo and K Iwano
Orthopaedic Section, Sagamihara National Hospital, Kanagawa Prefecture, Japan.
Thirty-seven elbows in thirty-six patients who had rheumatoid arthritis had
a total elbow arthroplasty with insertion of a non-constrained
surface-replacement prosthesis. The patients were followed for an average
of nine years and six months, the longest follow-up being seventeen years.
A good result was seen in twenty-nine elbows; a fair result, in one; and a
poor result, in seven. The reasons for the poor results were gross
posterior displacement of the humeral component in five elbows, persistent
subluxation with pain in one, and recurrent ankylosis in one. Of the five
elbows that had gross posterior displacement, four had a revision operation
with a new humeral component, and a satisfactory result was eventually
achieved. Radiographic examination revealed various degrees of proximal
subsidence of the humeral component in 70 per cent of the elbows. However,
in most of the elbows the subsidence was not progressive and was compatible
with a good clinical result. In contrast, the rate of loosening of the
ulnar component was low; loosening was seen in only 5 per cent of the
elbows. Seventeen elbows were followed for ten years or more, and
comparison of the clinical results in the intermediate period with those at
the most recent review revealed that the results improved with time.
Because of the number of elbows in which subsidence of the humeral
component developed, we now use a humeral component with an intramedullary
stem, and were no longer recommend the use of our Type-1 and Type-2
prostheses.
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