Total elbow arthroplasty with the Kudo prosthesis.

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Biomedical Engineering

Background:

• Rheumatoid arthritis frequently causes severe elbow joint destruction.
• Total elbow replacement is a treatment option for end-stage rheumatoid arthritis of the elbow.
• The Kudo type-4 prosthesis is one implant used for total elbow arthroplasty.

Purpose of the Study:

• To evaluate the long-term outcomes of Kudo type-4 total elbow replacements in patients with rheumatoid arthritis.
• To identify the main complications and reasons for revision surgery in this patient cohort.

Main Methods:

• A retrospective review of 57 Kudo type-4 total elbow replacements performed between 1990 and 1997.
• Evaluation of 44 elbows in 34 patients at an average follow-up of 7 years using the Mayo Clinic Performance Index.
• Analysis of complications, revision rates, and correlation with preoperative radiographic joint destruction.

Main Results:

• At an average 7-year follow-up, 29 out of 44 elbows (66%) demonstrated excellent or good outcomes.
• The most frequent complications were intraoperative fractures and ulnar neuropathy.
• Loosening of the ulnar component and breakage of the humeral component were the primary indications for revision surgery.
• No cases of luxation were observed.
• Preoperative radiographic joint destruction did not correlate with the revision rate.

Conclusions:

• Kudo type-4 total elbow replacement can provide satisfactory long-term results for rheumatoid arthritis patients.
• Surgeons should be aware of potential complications such as intraoperative fractures and ulnar neuropathy.
• Component wear and loosening are significant factors influencing the need for revision surgery.