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.
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.
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.
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.