Comparison of survivorship between standard and long-stem souter-strathclyde total elbow arthroplasty

This study compared 107 cases of rheumatoid arthritis that had the long-stem humeral component of the Souter-Strathclyde total elbow arthroplasty introduced as a primary procedure with a similar group of 202 cases that had the standard component. Both groups were comparable with regard to age range and sex ratio. Follow-up of the longer-stem component was somewhat shorter, being a mean of 4.4 years as opposed to 9.3 years. Kaplan-Meier survival analyses were undertaken for both revision and radiologic loosening of components as terminal events. There was no significant difference between the cumulative survival of the standard and long-stem humeral implants when revision was the endpoint. Although survival of both implants was similar, the reasons for this were different. More specifically, for the standard humeral component, 25 out of 32 revisions were for humeral loosening. For the long stem, however, 5 out of a total of 7 revisions were due to instability; no long-stem humeral component had been revised for loosening. In addition, linking the components by way of a snap-fit component was associated with a higher rate of loosening; more specifically, 5 out of 16 cases were revised. As a result of this study, we recommend the use of a long-stem Souter-Strathclyde humeral component as a primary implant. Other crucial components for long-stem survival, however, are surgical technique and alignment of the implant.