Results of custom-fit, noncemented, semiconstrained total elbow arthroplasty for inflammatory arthritis at an average of eighteen years of follow-up.
Academic Article
Overview
abstract
BACKGROUND: The literature available on the results after noncemented total elbow arthroplasty (TEA) in inflammatory arthritis is limited. METHODS: Ten patients (7 women, 3 men; 14 elbows total) who underwent custom, noncemented TEA from 1988 to 1995 were retrospectively reviewed. The average age was 28 years (range, 17-45 years). Four patients (4 elbows) had rheumatoid arthritis, and 6 patients (10 elbows) had juvenile rheumatoid arthritis. The mean follow-up was 18 years. All patients underwent a custom, noncemented, semiconstrained TEA with a plasma spray surface designed from preoperative computed tomography scan to achieve metaphyseal fit. The primary outcome was the Mayo Elbow Performance Score, and secondary outcomes were flexion and rotation arc of motion. Intraoperative and postoperative complications and revisions performed were also recorded. Radiographs taken at final follow-up were evaluated for evidence of loosening. RESULTS: The Mayo Elbow Performance Score improved from a mean of 35 preoperatively to a mean of 91 postoperatively. Flexion arc of motion improved from 50° preoperatively to 111° postoperatively, and rotation arc improved from 75° preoperatively to 145° postoperatively. Four patients underwent bushing revision at 8, 8, 22, and 22 years (29%), respectively, and there was 1 deep infection (7%). One patient had an intraoperative fracture in the humerus that did not require further treatment. On final radiographic follow-up at a mean of 18 years, all the components were fully ingrown, and there was no evidence of loosening or loss of fixation. CONCLUSION: In the younger population with inflammatory arthritis, noncemented TEA has reliable outcomes clinically and radiographically at long-term follow-up.
