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 Shoulder/Elbow Test 4: The Elbow: Arthroplasty, Trauma
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:465-473 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Primary Souter-Strathclyde Total Elbow Prosthesis in Rheumatoid Arthritis

J.C.T. van der Lugt, MD1, R.B. Geskus, PhD1 and P.M. Rozing, MD, PhD1

1 Department of Orthopaedic Surgery (J.C.T.v.d.L. and P.M.R.) and Department of Medical Statistics (R.B.G.), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail address for J.C.T. van der Lugt: j.c.t.van_der_lugt{at}lumc.nl

Investigation performed at the Leiden University Medical Center, Leiden, The Netherlands

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Total elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis.

Methods: Between June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter.

Results: Six of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years.

Conclusions: Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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