This matched retrospective cohort compares capitellocondylar total elbow arthroplasty in rheumatoid patients after a failed radial head excision and synovectomy versus primary arthroplasty. It asks whether prior elbow-preserving surgery compromises the results of later total elbow replacement. All 46 elbows used the same unconstrained implant at one institution, matched for age, gender, side, follow-up, and approach.
When you convert a previously operated rheumatoid elbow to an unconstrained total elbow, expect a less stable and less durable result than a primary replacement.
The mechanism is soft-tissue imbalance: removing the radial head takes away the lateral buttress and lets the radius migrate proximally, while medial gutter scarring shortens the medial collateral ligament. Those adhesions can feel stable in the OR, then stretch and produce late instability.
Practical rules from this paper: clear the medial gutter to restore MCL length, avoid a full anterior capsulotomy, and accept no more than 1 to 2 mm of distraction on trial at 90 degrees with the forearm pronated. Have a semiconstrained implant available. If you cannot achieve stability after balancing, or bone stock is poor, use the more constrained device.
For low-demand elderly rheumatoid patients, consider primary arthroplasty; for younger patients, preserve the collateral ligaments so future reconstruction stays possible.
This matched retrospective cohort compares capitellocondylar total elbow arthroplasty in rheumatoid patients after a failed radial head excision and synovectomy versus primary arthroplasty. It asks whether prior elbow-preserving surgery compromises the results of later total elbow replacement. All 46 elbows used the same unconstrained implant at one institution, matched for age, gender, side, follow-up, and approach.
When you convert a previously operated rheumatoid elbow to an unconstrained total elbow, expect a less stable and less durable result than a primary replacement.
The mechanism is soft-tissue imbalance: removing the radial head takes away the lateral buttress and lets the radius migrate proximally, while medial gutter scarring shortens the medial collateral ligament. Those adhesions can feel stable in the OR, then stretch and produce late instability.
Practical rules from this paper: clear the medial gutter to restore MCL length, avoid a full anterior capsulotomy, and accept no more than 1 to 2 mm of distraction on trial at 90 degrees with the forearm pronated. Have a semiconstrained implant available. If you cannot achieve stability after balancing, or bone stock is poor, use the more constrained device.
For low-demand elderly rheumatoid patients, consider primary arthroplasty; for younger patients, preserve the collateral ligaments so future reconstruction stays possible.