Sanchez-Sotelo, J Bone Joint Surg Am 2016 - Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis: 461 Elbows over Three Decades - Article Summary

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis: 461 Elbows over Three Decades

Sanchez-Sotelo, Morrey, et al.·J Bone Joint Surg Am·2016·103 citations·Retrospective cohort

Background

Elbow arthroplasty is the treatment of choice for end-stage rheumatoid arthritis (RA). The purpose of this study was to determine the long-term outcome of a linked semiconstrained elbow arthroplasty implant design in patients with RA.

Methods

Between 1982 and 2006, 461 primary total elbow arthroplasties using the Coonrad-Morrey prosthesis were performed in 387 patients with RA.
55 of the arthroplasties were performed to treat concurrent traumatic or posttraumatic conditions.
There were 305 women (365 elbows, 79%) and 82 men (96 elbows, 21%).
10 patients (10 elbows) were lost to follow-up, 9 patients (10 elbows) died, and 6 patients (6 elbows) underwent revision surgery within the first 2 years.
For the 435 elbows (362 patients, 94%) with a minimum of 2 years of follow-up, the median follow-up was 10 years (range, 2 to 30 years).

Results

At the most recent follow-up, 49 (11%) of the elbows had undergone component revision or removal (deep infection, 10 elbows; and mechanical failure, 39 elbows).
Eight additional elbows were considered to have radiographic evidence of loosening.
For surviving implants followed for a minimum of 2 years, the median Mayo Elbow Performance Score (MEPS) was 90 points.
Bushing wear was identified in 71 (23%) of the surviving elbows with a minimum of 2 years of radiographic follow-up; however, only 2% of the elbows had been revised for isolated bushing wear.
The rate of survivorship free of implant revision or removal for any reason was 92% (95% confidence interval [CI] = 88% to 94%) at 10 years, 83% (95% CI = 77% to 88%) at 15 years, and 68% (95% CI = 56% to 78%) at 20 years.
The survivorship at 20 years was 88% (95% CI = 83% to 92%) with revision due to aseptic loosening as the end point and 89% (95% CI = 77% to 95%) with isolated bushing exchange as the end point.
Risk factors for implant revision for any cause included male sex, a history of concomitant traumatic pathology, and implantation of an ulnar component with a polymethylmethacrylate surface finish.

Conclusions

Elbow arthroplasty using a cemented linked semiconstrained elbow arthroplasty provides satisfactory clinical results in the treatment of RA with a reasonable rate of survivorship free of mechanical failure at 20 years. Although bushing wear was identified on radiographs in approximately one-fourth of the patients, revision for isolated bushing wear was uncommon.

Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.

Core

Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis: 461 Elbows over Three Decades

Sanchez-Sotelo, Morrey, et al.J Bone Joint Surg Am2016103 citationsRetrospective cohort