[Complete elbow prosthesis for inflammatory and hemophiliac arthropathy. A retrospective analysis of 22 cases]

We retrospectively analysed 22 total elbow prostheses (8 GSB III, 14 Kudo) implanted because of inflammatory (19 elbows) or haemophilic (3 elbows) diseases, in order to evaluate: 1) functional result and mobility; 2) frequency of loosening. The results were evaluated after an average of 36 months [16-67] by an observer who took part neither in therapeutic decisions, nor in surgery. Twenty elbows were associated with severe pain before surgery, while 16 elbows were painless and 5 had occasional pain at follow-up. The range of flexion was 133 degrees (from 96 degrees to 50 degrees) and the average range of extension was 32 degrees (extension ranged from [-10 to -90 degrees]). Only 2 elbows had a range of pronation-supination less than 100 degrees, the average range of pronation was 75 degrees (from [30 degrees to 90 degrees]) and 75 degrees (from [20 degrees to 90 degrees]) in supination. The functional results were comparable for the two types of prostheses. We observed 2 postoperative dislocations (1 GSB III and 1 Kudo) which were stabilized after surgical revision; and one late dislocation (1 GSB III) related to friction-wear. We identified incomplete ossification between the humerus and ulna in the 8 GSB III and 10 of the 14 Kudo. A reduction of 20 degrees in all mobility sectors was identified with the Kudo when ossifications were observed. Two implants became loose : the two pieces of 1 GSB III and the ulnar piece of 1 Kudo. One humeral piece of Kudo was broken at the junction between the stem and the trochlea. Three other GSB III had severe osteolysis which could compromise fixation or subsequent prosthetic revision. For the inflammatory and haemophilic arthropathies, the elbow prosthesis gave painless and satisfactory mobility for the short and medium term. The loosening of the 22 prostheses and the frequency of osteolysis with the GSB III (3/8) justify a longer follow-up.