The Kudo total elbow arthroplasty in patients with rheumatoid arthritis

doi:10.1016/j.jse.2004.02.017

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 5, September–October 2004, Pages 542-547

https://doi.org/10.1016/j.jse.2004.02.017 Get rights and content

Abstract

A Kudo total elbow arthroplasty (TEA) was performed in 36 elbows in 35 patients with rheumatoid arthritis. Of those 35, 4 died, 6 prostheses were revised, and 2 were lost to follow-up. Twenty-four elbows with a mean follow-up of 58 months were radiologically and clinically reviewed. Sixteen were scored as excellent by use of the Mayo score and Hospital for Special Surgery 2 score. The mean increase in active motion was 25°. Two humeral and four ulnar radiologic loosenings were noted. Two early dislocations were successfully treated with closed reduction and cast immobilization, two patients used an elbow brace after the closed reduction, and one patient underwent a resection arthroplasty for instability and deep wound infection. Four aseptic loosenings, of which three had an intraoperative fracture at the index operation and one had instability, were revised. Despite initially excellent results, longer follow-up of TEA in rheumatoid patients demonstrated deterioration of the outcome and increased loosening.

Section snippets

Materials and methods

Between 1991 and 2002, 36 elbows (22 right and 14 left) were replaced with a Kudo prosthesis (Biomet Ltd, South Glamorgan, United Kingdom) (type 4 and 5) in 35 patients with RA. All elbows were in Larsen stages 4 and 5.¹⁵ There were 12 men and 23 women with a mean age of 57.5 years (range, 36-74 years). The mean duration between the onset of rheumatoid disease and the prosthetic implantation was 17 years (range, 3-38 years). An open synovectomy and radial head excision had been performed

Clinical results

The results are summarized in Table I. Twenty-four elbows were followed for a mean of 58 months (range, 8-114 months) postoperatively; 4 patients died, 6 were excluded because of revision, and 2 were lost during follow-up. Postoperatively, 14 patients were pain-free, 7 had mild pain, and 3 had moderate pain. Sixteen patients had excellent or good results by use of the Hospital for Special Surgery 2 score, and fifteen had excellent or good results by use of the Mayo score.

There was improvement

Discussion

The number of elbow arthroplasties performed for the 9-year period in this study is probably typical for most surgeons performing elbow arthroplasty for RA. A preliminary report was published from the same department in 1998, with mainly excellent and good results.¹¹ Resurfacing prostheses have the advantage of minimal bone resection and minimal stresses at the interfaces. Patients with RA affecting multiple joints have lower functional demands than those with other diagnoses. Although our

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Total elbow arthroplasty continues to evolve as our understanding and techniques have improved. Elbow arthroplasty can successfully improve pain, motion and function for patients with many different pathologies of the elbow. However, the complication rate after total elbow arthroplasty remains higher than for other joints. Long-term success is best for patients with inflammatory arthritis but the indications for treatment of fracture sequelae and osteoarthritis in patients with higher functional demands continue to grow. The most common complications of elbow arthroplasty include infection, implant loosening, component wear, triceps weakness and ulnar neuropathy. Revision surgery can achieve good clinical results when necessary, but failed elbow arthroplasties continue to be a challenging area of orthopaedics.
Heterotopic ossification after total elbow arthroplasty: a systematic review
2019, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
In total, 59 patients (3%) were symptomatic and 13 (0.6%) underwent revision because of HO. An HO patient was classified as symptomatic if (1) the study authors reported symptoms, (2) the patient underwent revision because of HO, or (3) the patient had less than 120° of flexion (Appendix S2).1-9,11-19,21,22,24,25,27-29,31,33-38,40-43,46,47,49-52,54,56,57 Female patients comprised 73% (SD, 2.3%; range, 19%-100%) of the included patients, and the weighted mean age of the patients was 62 years (SD, 1.4 years; range, 31-85 years).
Heterotopic ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases, it is asymptomatic; however, in some patients, it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report the incidence, risk factors, prophylaxis, and management of HO after TEA.
A systematic search was conducted using MEDLINE, Embase, and PubMed to retrieve all relevant studies evaluating the occurrence of HO after TEA. The search was performed in duplicate, and a quality assessment of all included studies was performed.
A total of 1907 studies were retrieved, of which 45 were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Fewer than 1% of patients went on to undergo surgical excision of HO, with outcomes after surgery reported as good or excellent as assessed by range of motion and the Mayo Elbow Performance Score. HO appears more likely to develop in patients undergoing TEA because of ankylosis, primary osteoarthritis, and distal humeral fractures. Surgical intervention is more likely to be required in patients in whom HO develops after TEA performed for ankylosis and post-traumatic osteoarthritis.
HO is an uncommon complication after TEA, with most patients in whom HO develops being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high-risk patients is uncertain, and future studies are required to clarify its usefulness.
Macroscopic investigation of failed Kudo type 5 total elbow arthroplasty
2018, Journal of Shoulder and Elbow Surgery
On the basis of the intra-articular findings during Kudo type 5 elbow prosthesis revision surgery, we infer the mechanisms leading to implant failure.
We performed primary Kudo type 5 total elbow arthroplasty on 60 rheumatoid elbows in 45 patients between 1994 and 2003. Revision surgery was performed in 8 patients (9 elbows) because of implant failure. We radiographically assessed their status before this surgical procedure and then assessed the surgical intra-articular findings based on surgery records and photographs.
In all cases, revision surgery was necessitated by failure of the ulnar component. There were 2 types of implant failure: fracture of the ulnar component neck (n = 3) and loosening of the ulnar component (n = 6). In the latter group, 2 elbows exhibited valgus deformity of the retrieved ulnar component. There were no cases of metallosis or wear of the articular surface.
This study describes the types of implant failure in unlinked Kudo type 5 total elbow arthroplasties with all-polyethylene ulnar components based on the intra-articular findings. Failure of the all-polyethylene ulnar component could have been caused by ulnar neck distortion that occurred prior to polyethylene wear on the joint surface. In addition, valgus stress on the elbow joint may have contributed to these implant failures.
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Radial head, radiocapitellar and total elbow arthroplasties: A review of recent literature
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Citation Excerpt :
Radiographic periprosthetic radiolucencies were present in 10–55% of cases. The analysis of these studies did not enable us to always identify the site of radiolucencies or to determine whether they were associated with significant pain or needed revision.65–75 Of the 441 reported cases, 70 (16%) underwent revision with a prevalence of 14–22% depending on the study, the most common reasons being aseptic loosening, instability, periprosthetic fractures and infections.
The outcome of prosthetic elbow surgery is continually evolving. We thoroughly reviewed the literature on this issue to analyse the indications, outcomes and complications of the numerous types of implants currently in use. Radial head replacement is recommended in comminuted fractures of the radial head and in post-traumatic conditions. Medium- and long-term results prove to be satisfactory in the majority of cases, with no evidence to indicate that some prostheses (monopolar vs. bipolar; cemented vs. press-fit) are more effective than others; nonetheless, the bipolar-cemented implant was found to be associated with a lower revision rate than other prostheses. Unicompartmental arthroplasty has recently been used for the treatment of osteoarthritis and rheumatoid arthritis when the lateral compartment is prevalently involved; the results reported to date have been encouraging, although further studies are warranted to confirm the validity of these implants. Total elbow arthroplasty is performed in a range of conditions, including distal humerus fractures in the elderly and elbow arthritis. In the former condition, linked elbow replacement yields excellent results with few complications and a low revision rate. In elbow arthritis, total elbow arthroplasty is indicated when patients suffer from disabling pain, stiffness and/or instability that prevent them from performing daily activities. Unlinked elbow arthroplasty, which is used above all in rheumatoid arthritis, also yields satisfactory results, although the risk of instability persists. The use of linked elbow arthroplasty, which yields similar results but lower revision rates, has consequently increased. Lastly, the results yielded by linked elbow prosthesis in post-traumatic conditions are good, although not quite as good as those obtained in rheumatoid arthritis. Early mechanical failure may occur in younger and more active patients after elbow arthroplasty. However, the careful selection of patients who are prepared to accept functional limitations imposed by elbow implants will enable indications for elbow arthroplasty to be extended to young subjects, particularly when no other therapeutic options are available.
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Total elbow arthroplasty continues to evolve and its indications have expanded to include acute distal humerus fractures, post-traumatic osteoarthritis, distal humerus nonunions and reconstruction following tumor resection. Elbow arthroplasty is successful with regard to pain relief, motion and function. Its complicate rate, however, remains higher than arthroplasty of other joints. The overall success rate is best for patients with inflammatory arthritis and elderly patients with acute distal humerus fractures and is worse for patients with post-traumatic osteoarthritis. The most common complications of elbow arthroplasty include infection, loosening, wear, triceps weakness and ulnar neuropathy. When revision surgery becomes necessary, bone augmentation techniques provide a reasonable outcome.

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Original articleThe Kudo total elbow arthroplasty in patients with rheumatoid arthritis

Abstract

Section snippets

Materials and methods

Clinical results

Discussion

Curr Orthop

J Shoulder Elbow Surg

Orthop Clin North Am

Curr Orthop

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Orthop Clin North Am

J Hand Surg

Synovectomy of the elbow and radial head excision in rheumatoid arthritis

J Bone Joint Surg Br

Total elbow arthroplasty in rheumatoid arthritis20 GSBIII prostheses followed 2-5 years

Acta Orthop Scand

Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis

J Bone Joint Surgery Am

The Coonrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A 10-15 year follow-up study

J Bone Joint Surg Am

Total elbow replacement in the treatment of rheumatoid disease

Clin Orthop

Total elbow arthroplasty with a non-constrained surface-replacement prosthesis in patients who have rheumatoid arthritis

J Bone Joint Surg Am

Results of total elbow arthroplasty after excision of the radial head and synovectomy in patients who had rheumatoid arthritis

J Bone Joint Surg Am

Humeral hemiarthroplasty of the elbow joint in young patients with rheumatoid arthritisa report on 7 arthroplasties

J Arthroplasty

Original article
The Kudo total elbow arthroplasty in patients with rheumatoid arthritis