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PubMed2001

[GUEPAR total elbow prosthesis in rheumatoid arthritis. A multicentric retrospective study of 38 cases with an average 4-year follow-up].

PURPOSE OF THE STUDY: We conducted a multicentric retrospective analysis of outcome after implantation of 38 GUEPAR elbow prostheses in 36 patients with rheumatoid polyarthritis. MATERIAL AND METHODS: The GUEPAR elbow prosthesis is an anatomic prosthesis developed in 1985 by the Groupe pour l'Utilisation et l'Etude des Prothèses Articulaires (GUEPAR). The recommended surgical technique is described. Patients included in this series had moderate to severe persistent elbow pain. Preoperative motion was 113 degrees flexion with a mean 41 degrees extension deficit. The mean global Mayo Clinic score was 32/100; clinically, the overall assessment was poor in 8 and mediocre in 30. Radiographically there were 16 grade III, 16 grade IV and 4 grade V elbows in the Larsen classification. Two cases were arthroplasty revisions. RESULTS: All patients were seen at a mean 47.6 months follow-up (12 to 97 months). There were two early failures (1 infection and 1 instability) leading to ablation of the prosthesis. Results were analyzed for the 36 remaining arthroplasties. Total pain relief was achieved in 18 cases with only occasional pain in 17 others. Postoperative motion was 132 degrees flexion with a 30 degrees extension deficit, giving a mean 30 degrees gain. The global Mayo Clinic score was 85/100 with 32 excellent, 3 good and 1 mediocre results. Radiography revealed 2 cases of loosening of the humeral component and 1 bipolar loosening that had not required revision at last follow-up. Prosthetic instability was the most frequent among the early and late complications. DISCUSSION: Total elbow arthroplasty is a useful therapeutic option among the treatments proposed (including chemical or isotopic synoviothesis, synovectomy, arthroplastic resection) for rheumatoid elbows. It is indicated for Larsen grades III, IV and V and provides good functional outcome and nearly constant pain relief with an amplitude greater than the 100 degrees, generally accepted as functionally useful. In light of our experience we propose certain modifications of the current GUEPAR implant: adjunction of a condylar extension to the humeral component in order to reduce rotation stress and thus avoid humeral loosening and a radial head element to limit the risk of instability.

Adult↗
PubMed1993

In vitro stability of an unconstrained total elbow prosthesis. Influence of axial loading and joint flexion angle.

Total elbow arthroplasty is often used to replace elbow joints that have been severely damaged by arthritis or trauma. A great disparity of designs exists, however, in currently available elbow prostheses. This study evaluated the intrinsic stability of one popular resurfacing implant, the Capitellocondylar (Johnson and Johnson Orthopaedics, Inc., New Brunswick, NJ) total elbow. The in vitro response of this unconstrained prosthesis to valgus-varus and supination-pronation loading was investigated using a materials testing machine. The influence of compressive loading and flexion angle on the intrinsic stability of the prosthesis was studied. The Capitellocondylar prosthesis was found to have little intrinsic constraint, relying on external forces for component stabilization. Dislocations were common at 111 N of compressive loading, while larger loads progressively stabilized the prosthesis. Joint flexion angle had little influence on the intrinsic constraint of the implant except to increase varus stability at lower flexion angles. The Capitellocondylar total elbow prosthesis, as designed by F. C. Ewald, behaves as an unconstrained implant. Adequate soft tissue supports, which are properly balanced to provide controlled loading, are essential to prevent instability of this arthroplasty.

Biomechanical Phenomena↗
PubMed1984

A review of the Liverpool elbow prosthesis from 1974 to 1982.

Eighty elbows in 65 patients with an average age of 57 years have had two-part non-constrained Liverpool elbow arthroplasties performed since 1974. Fifty-five had rheumatoid arthritis, eight osteoarthritis or ankylosis secondary to injury, one osteochondritis dissecans and one pyknodysostosis. The average preoperative range of movement was 42 degrees to 112 degrees with 47 degrees of pronation and 42 degrees of supination. There was significant gain in the arc of movements at follow-up: 32 degrees in the extension-flexion range (average range 32 degrees to 134 degrees of flexion) and 42 degrees in forearm rotation (average pronation 69 degrees and supination 62 degrees). Before operation severe pain was the predominating symptom in 43 elbows (53.8%) but after replacement there was only moderate pain in five elbows (6.2%). The results were excellent in 42 (52.5%), good in 15 (18.7%), fair in 9 (11.3%) and unsatisfactory or poor in 14 (17.5%). Eight elbows required revision of the arthroplasty: three were post-traumatic, disorganised or osteoarthritic joints, three rheumatoid and both elbows in the patient with pyknodysostosis. Loosening of the prosthesis (particularly the humeral component) was the common factor necessitating revision. Of six rheumatoid elbows needing removal of the implant, four had deep infection, one had a dislodged humeral component as a result of injury and in one a divided olecranon had developed non-union. Rheumatoid elbows benefited more than post-traumatic arthritic elbows from the operation. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Late results of the Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. 6/19 implants loose after 5 years.

We performed total elbow replacement, using the Souter-Strathclyde prosthesis in 19 elbows of 18 patients with rheumatoid arthritis and followed the patients for 5 (1-11) years. Pain relief was achieved initially in all patients. The average range of flexion-extension was increased by 12 degrees and pronation-supination by 40 degrees. There were no infections. 1 patient sustained an intraoperative fracture of the medial epicondyle, 3 patients developed neuropathies and 1 patient had an immediate postoperative dislocation of the joint. At follow-up, 6 prostheses had radiographic loosening, with sagittal titling and migration of 4 humeral components. 2 patients had clinical symptoms of loosening.

Aged↗
PubMed1994

The modified Liverpool total elbow prosthesis.

We present the results of the modified Liverpool total elbow joint replacement. The humeral component of the original prosthesis was modified because of a high incidence of loosening. 19 patients who had total elbow joint replacement for rheumatoid arthritis were reviewed 8 years after surgery. 14 patients had the modified prosthesis implanted. There was dramatic relief of pain and improvement in function following surgery. There was a reduced fixed flexion deformity and an increased range of movement with the modified prosthesis. None of the humeral components of the modified prosthesis have as yet required revision. In selected patients therefore, this operation is a predictably successful procedure. Our follow-up confirms the ability of the modified prosthesis to provide a pain-free, stable and mobile joint.

Aged↗
PubMed2002

[Kudo non-constrained elbow prosthesis for inflammatory and hemophilic joint disease: analysis in 30 cases].

PURPOSE OF THE STUDY: We analyzed retrospectively 30 Kudo non-constrained elbow prostheses to determine: 1) functional outcome and mobility, 2) frequency of loosening and any complications. MATERIAL AND METHODS: From 1992 to 1998, 30 Kudo total elbow arthroplasties were performed in 29 patients, mean age 55 years. Mean follow-up was 36 months. These patients had severe joint disease: rheumatoid arthritis for 24, psoriatic arthritis for 2, and hemophilic arthritis for 3. The 29 patients experienced severe pain before surgery. RESULTS: At review, 21 elbows were pain free and the 9 others had only occasional pain. Among these 9 elbows, 3 exhibited a rupture of the humeral implant; one had already been revised but remained painful. One patient had a stiff painful elbow after reflex dystrophy and five others had pain but no other complication. Twenty-six patients were satisfied or very satisfied. Three patients were unsatisfied because of the humeral implant fracture. Mean mobility at last follow-up was: 128 degrees flexion, -35 degrees extension, 72 degrees pronation, and 74 degrees supination. Mean gain in flexion-extension was 15 degrees and mean gain in pronosupination was 3 degrees. Pronosupination was greater than 100 degrees except for two patients. There was one immediate post-operative dislocation with failure of prolonged orthopedic treatment after reduction; this patient underwent revision reconstruction with repair of the ulnar collateral ligaments (plasty of the medial collateral ligament with a synthetic ligament). Painful movement of the radial stump was observed with one Kudo prosthesis and required resection to achieve cure. In all, there were 3 fractures of the Kudo I prosthesis at the junction of the trochlea and the humeral stem. Among these patients, one underwent revision due to persistent pain, and two others with currently acceptable symptoms are awaiting revision. At last follow-up, we had: 1 ulnar loosening associated with cortical thinning facing the end of the ulnar implant that had migrated and showed a circular lucent line measuring > 1 mm and progressing; 9 unique ulnar lucent lines measuring<1 mm without progression at the proximal part of the implant (6 at the bone-cement interface and 3 at the bone-implant interface); 3 humeral radiolucent lines (<1 mm without progression) on the distal part of the Kudo II humeral stems corresponding to a zone without surfacing. We also observed 13 cases of incomplete ossification between the humerus and ulna and among these 13, 7 elbows had amplitudes of less than 100 degrees. DISCUSSION AND CONCLUSION: Elbow arthroplasty can restore a painless joint and maintain or improve elbow motion. The procedure is indicated when the joint disease impair daily life activities. Final mobility basically depends on the preoperative mobility. The bone stock remains the greatest problem with these resurfaced prostheses. The GUEPAR elbow prosthesis would appear to be more adapted due to the reconstruction of the trochlea. Resection of the radial head is a source of instability for elbow prostheses and should lead to the design of three-compartment prostheses.

Activities of Daily Living↗
PubMed1998

Results of the Kudo elbow prosthesis in patients with rheumatoid arthritis: a preliminary report.

Sixteen elbows in 15 rheumatoid arthritis patients had a total elbow replacement with insertion of a non-constrained surface-replacement prosthesis. One patient died of an unrelated cause, but all the others were available for follow-up (mean follow-up period: 35.4 months). The results were graded according to a modified version of the Morrey elbow score. A good result was seen in 13 elbows and a fair result in two. One infection occurred, which was cured with intravenous antibiotics and maintenance of the prosthesis in place; however, recurrent dislocation persisted. Another patient had postoperative instability with recurrent subluxations. Eleven patients were very satisfied and one was satisfied. The total active range of motion increased significantly from 70.3 degrees (SD 29.6) to 97.0 degrees (SD 15.4), mainly by increased flexion. The modified Morrey score increased significantly from 32.7 (SD 13.1) to 89.3 (SD 10.3). Pain decreased from severe (n = 12) and moderate (n = 3) preoperatively to mild (n = 5) and absent (n = 10) postoperatively.

Adult↗
PubMed1991

Use of the Souter-Strathclyde total elbow prosthesis in patients who have rheumatoid arthritis.

Thirty-three patients had thirty-four consecutive primary arthroplasties, with use of the Souter-Strathclyde cemented unconstrained prosthesis, for severe rheumatoid arthritis of the elbow. The minimum duration of follow-up for inclusion in the study was two years. Three patients died. Four arthroplasties were revised: three, because of irreducible dislocation immediately after the operation and one, because of loosening without infection. One prosthesis was removed because of a late deep infection. In most of the remaining twenty-five patients (twenty-six arthroplasties), who had an average duration of follow-up of four years (range, two to eight years), pain was markedly less or had resolved completely, and the function of the elbow was greatly improved.

Adult↗