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The Journal of Bone and Joint Surgery (American) 83:1506-1513 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Kudo Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis

A Long-Term Follow-up Study

Nobuyuki Tanaka, MD, Hiroshi Kudo, MD, Kunio Iwano, MD, Hisashi Sakahashi, MD, Eiichi Sato, MD and Seiichi Ishii, MD

Investigation performed at Sapporo Gorinbashi Orthopedic Hospital, Sapporo, Hokkaido, Japan
Nobuyuki Tanaka, MD
Hisashi Sakahashi, MD
Eiichi Sato, MD
Sapporo Gorinbashi Orthopedic Hospital, Gorinbashi Health Care Facilities and Hospitals, 2-1, Kawazoe, Minami-ku, Sapporo, Hokkaido, 005-0802, Japan. E-mail address for N. Tanaka: nobuyuki-tanaka{at}hokkaido.med.or.jp
Hiroshi Kudo, MD
Kunio Iwano, MD
Department of Orthopedic Surgery, Sagamihara National Hospital, Sakuradai 18-1, Sagamihara, Kanagawa Prefecture, 228-8522, Japan

Seiichi Ishii, MD
Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, South 1 West 16, Chyou-ku, Sapporo, Hokkaido, 060-0061, Japan

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

Background: Improvements in the design of total elbow prostheses over the last two decades have led to better and more consistent results. The type-3 Kudo total elbow prosthesis was developed in 1980. The long-term results of use of this implant have not been reported. Because it is an unlinked prosthesis, it is not known whether preservation of the anterior oblique component of the ulnar collateral ligament at the time of implantation is important.

Methods: A type-3 Kudo total elbow arthroplasty with cement was performed in forty-seven patients (fifty elbows) with rheumatoid arthritis. Revision rates, clinical symptoms, postoperative complications, and radiographic changes were assessed eleven to sixteen years (mean, thirteen years) postoperatively.

Results: The overall survival rate of the prosthesis was 90% at sixteen years. The mean Mayo elbow performance scores were all poor (mean overall score, 43 points) initially. The overall score was substantially improved at both the intermediate follow-up examination (four to six years after the operation) and the late follow-up examination (eleven to sixteen years after the operation), to 81 and 77 points, respectively. The overall rate of radiolucency about the humeral component was 45% at the intermediate follow-up examination and 100% at the long-term follow-up examination. The rate of radiolucency about the ulnar component at the intermediate and late follow-up examinations was 4.3% and 8.9%, respectively. No great differences in results were found with preservation of the anterior oblique component of the ulnar collateral ligament.

Conclusions: This long-term follow-up study showed acceptable results of the type-3 Kudo total elbow arthroplasty in patients with rheumatoid arthritis. Preservation of the ulnar collateral ligament does not seem to be necessary when performing this procedure.


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