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The Journal of Bone and Joint Surgery, Vol 75, Issue 4 498-507, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Capitellocondylar total elbow replacement in rheumatoid arthritis. Long-term results
FC Ewald, ED Simmons, JA Sullivan, WH Thomas, RD Scott, R Poss, TS Thornhill and CB Sledge
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
We evaluated the long-term results of 202 capitellocondylar total elbow
replacements that had been performed, from July 1974 through June 1987, in
172 patients. The duration of follow-up averaged sixty-nine months (range,
twenty-four to 178 months). At the most recent follow-up examination, use
of a 100-point rating score demonstrated an improvement from an average
preoperative score of 26 points (range, 2 to 50 points) to an average
postoperative score of 91 points (range, 45 to 100 points). The most
improvement occurred in the categories of relief of pain, functional
status, and range of motion in all planes except extension. The
improvements in these categories and in the roentgenographic appearance
that were seen in the early postoperative period did not deteriorate with
time. The average preoperative arc of motion at the elbow ranged from -37
degrees of extension to 118 degrees of flexion. The average postoperative
arc of motion at the elbow ranged from -30 degrees of extension to 135
degrees of flexion. Supination improved from 45 degrees preoperatively to
64 degrees postoperatively; pronation improved from 56 degrees
preoperatively to 72 degrees postoperatively. The roentgenograms showed a
radiolucent line adjacent to eight humeral and nineteen ulnar components;
most of the lines were incomplete and one millimeter wide or less. Revision
of the prosthesis was necessary in three elbows (1.5 per cent) because of
loosening without infection, and in three additional elbows because of
dislocation of the prosthesis. Complications included deep infection in
three elbows (1.5 per cent); problems related to the wound in fifteen (7
per cent); permanent, partial sensory ulnar-nerve palsy in five (2.5 per
cent); permanent, partial motor ulnar-nerve palsy in one (0.5 per cent);
and dislocation in seven (3.5 per cent).
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