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Published on: July 5, 2011
Capitellocondylar total elbow replacement in late-stage rheumatoid arthritis
Janne Ovesen1, Bo Sanderhoff Olsen, Hans Viggo Johannsen
1Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, University Hospital, Aarhus, Denmark. janneo@get2net.dk
Insights
Capitellocondylar elbow replacements significantly improved pain relief and range of motion in rheumatoid arthritis patients. The functional prosthesis survival rate was 82.7% at a mean follow-up of 6.9 years.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Biomedical Engineering
Background:
- Rheumatoid arthritis (RA) frequently affects the elbow joint, causing pain and functional limitation.
- Total elbow arthroplasty (TEA) is an option for end-stage RA, but long-term outcomes require evaluation.
- Capitellocondylar prostheses are a specific type of TEA used for RA management.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of capitellocondylar elbow replacements in patients with rheumatoid arthritis.
- To assess pain relief, range of motion, implant survival, and complication rates.
- To determine the long-term efficacy of this prosthesis type in RA management.
Main Methods:
- A retrospective review of 51 capitellocondylar elbow replacements in 41 patients with end-stage RA.
- Patients were followed clinically and radiographically for a mean of 6.9 years post-operation.
- Data collected included pain levels, range of motion, implant survival, and incidence of complications.
Main Results:
- 91% of surviving elbows reported complete pain relief, with 9% experiencing only mild pain.
- Significant improvements were observed in mean flexion (43°), extension (16°), supination (24°), and pronation (26°).
- Implant survival was 82.7% at a mean of 8.6 years, with complications including infection, loosening, and instability.
Conclusions:
- Capitellocondylar elbow replacement provides substantial pain relief and functional improvement in RA patients.
- The prosthesis demonstrates a favorable survival rate, though complications necessitate careful patient selection and monitoring.
- This implant type is a viable option for managing end-stage rheumatoid arthritis of the elbow.
Abstract:
Between 1994 and 2000, 51 capitellocondylar elbow replacements were inserted in 41 patients. All patients had late-stage rheumatoid arthritis. The mean age at operation was 56 years (range, 25-78 years). There were 12 men and 29 women. At follow-up, 6 patients had died of unrelated causes with the implant in situ and without radiographic loosening, and 1 patient was lost to follow-up. The remaining 43 elbows in 34 patients were followed up clinically and radiographically at a mean of 6.9 years (range, 26-119 months). Relief of pain was complete in 91% of the surviving elbows, and in 9%, there was only mild pain. Pain-free range of motion at follow-up was significantly improved. Flexion increased a mean of 43 degrees ; extension, 16 degrees ; supination, 24 degrees and pronation, 26 degrees . Of the elbows, 7 underwent revision, 3 because of deep infection, 1 for aseptic loosening, and 3 because of instability. Other complications included 2 maltracking elbows, 2 triceps tendon ruptures, 2 cases of operative olecranon bursitis, and 2 ulnar nerve palsies. One elbow showed radiolucent lines of more than 1 mm in the circumference of the ulnar component; none of the other elbows showed any signs of progressive radiographic loosening. At a mean follow-up of 6.9 years, a functional prosthesis was retained in 82.7% of the elbows, and the mean survival of the implant was 8.6 years (95% CI, 7.8-9.5 years).
