This is a long-term retrospective review of 202 capitellocondylar (unconstrained, resurfacing) total elbow replacements in 172 rheumatoid patients. It asks whether the early functional and radiographic gains of this non-constrained design hold up over time, and what complication profile it carries. Mean follow-up was 69 months, extending to 14 years.
The core teaching point: an unconstrained resurfacing elbow works well in rheumatoid arthritis only when you respect its prerequisites.
Adequate bone stock and intact ligaments are mandatory, because stability comes from balanced soft tissues tensioned by appropriately sized components, not from implant constraint. When bone is deficient and three-point fixation is impossible, choose a more constrained (linked) design instead.
The approach matters enormously. Switching from a posterior to a lateral modified Kocher exposure cut ulnar-nerve palsy from 31% to 15% by keeping dissection lateral and preserving the ulnar collateral ligament and triceps. Releasing the fibrous arch protects the often-attenuated rheumatoid ulnar nerve during joint dislocation.
Remember the salvage logic: minimal bone is resected, so a failed capitellocondylar arthroplasty can convert to a stable resection arthroplasty as long as the olecranon is intact. This is why the authors urge implanting before the trochlea and trochlear notch are destroyed.
This is a long-term retrospective review of 202 capitellocondylar (unconstrained, resurfacing) total elbow replacements in 172 rheumatoid patients. It asks whether the early functional and radiographic gains of this non-constrained design hold up over time, and what complication profile it carries. Mean follow-up was 69 months, extending to 14 years.
The core teaching point: an unconstrained resurfacing elbow works well in rheumatoid arthritis only when you respect its prerequisites.
Adequate bone stock and intact ligaments are mandatory, because stability comes from balanced soft tissues tensioned by appropriately sized components, not from implant constraint. When bone is deficient and three-point fixation is impossible, choose a more constrained (linked) design instead.
The approach matters enormously. Switching from a posterior to a lateral modified Kocher exposure cut ulnar-nerve palsy from 31% to 15% by keeping dissection lateral and preserving the ulnar collateral ligament and triceps. Releasing the fibrous arch protects the often-attenuated rheumatoid ulnar nerve during joint dislocation.
Remember the salvage logic: minimal bone is resected, so a failed capitellocondylar arthroplasty can convert to a stable resection arthroplasty as long as the olecranon is intact. This is why the authors urge implanting before the trochlea and trochlear notch are destroyed.