Background: Total elbow arthroplasty is a well-established treatment
for the painful elbow joint in patients with rheumatoid arthritis. We present
the results of what we believe to be the first prospective study of the
Souter-Strathclyde total elbow prosthesis.
Methods: Between June 1982 and December 2000, 204 primary total
elbow prostheses were inserted in 166 patients who had rheumatoid arthritis.
No patient was lost to follow-up. The mean duration of follow-up was 6.4
years. All patients were examined preoperatively, at one and two years
postoperatively, and at regular intervals thereafter.
Results: Six of the 204 elbows had pain at rest at the time of the
latest follow-up. Ten patients (ten elbows) without previous neurological
symptoms had development of paresthesias in the distribution of the ulnar
nerve postoperatively. Patients who had pain at rest or at night and those who
had ulnar nerve symptoms preoperatively were found to have a significant
chance of having the same complaints postoperatively. Pain at rest or at night
and a decrease in function during the follow-up period were associated with
humeral loosening. Twenty-four elbows had revision of the total elbow
prosthesis because of loosening of the humeral component (ten), loosening
after fracture (six), dislocation (four), infection (two), restricted range of
motion (one), or fracture of the middle part of the humeral shaft, proximal to
the prosthesis (one). One prosthesis was removed because of humeral loosening,
and eight were removed because of deep infection. Another five prostheses were
radiographically loose at the time of the latest follow-up. The rate of
implant survival, according to the method of Kaplan-Meier, was 77.4% after ten
years and 65.2% after eighteen years.
Conclusions: Total elbow replacement is associated with a high
complication rate and therefore may be warranted only for seriously disabled
patients. Currently, the results associated with the Souter-Strathclyde total
elbow prosthesis are comparable with the results associated with other
prostheses, but loosening of the humeral component remains a concern.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.