Interposition arthroplasty of the elbow with rheumatoid arthritis

Radiographic bone loss and clinical outcome were evaluated at a median of 6 years after interposition arthroplasty was performed in 35 elbows with rheumatoid arthritis. Seven early postoperative complications, two major and five minor, occurred. Three elbows subsequently required total elbow replacement. Clinical results were good in terms of pain relief but only fair in terms of joint mobility and stability. Radiographic elbow destruction progressed to a higher Larsen stage in half of the elbows. Measurements revealed humeral bone loss in two thirds of the elbows and ulnar bone loss in one third. In comparison with total elbow replacement, the long-term results of interposition arthroplasty were found to be inferior, with a total elbow replacement being required in one tenth of the elbows in the long term. In addition, bone loss often became extensive, making reoperation difficult or impossible. The authors recommend total elbow replacement as the first choice in the surgical treatment of the painful elbow with rheumatoid arthritis and cartilage destruction.