Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis

Overview

Journal Bone Joint J

Specialties General Surgery
Orthopedics

Date 2020 Aug 1

PMID 32731835

Citations 8

Authors

Te-Feng A Chou

Hsuan-Hsiao Ma

Jou-Hua Wang

Shang-Wen Tsai

Cheng-Fong Chen

Po-Kuei Wu

Wei-Ming Chen

Affiliations

Soon will be listed here.

Abstract

Aims: The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome.

Methods: We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome.

Results: A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening.

Conclusion: TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: 2020;102-B(8):967-980.

Citing Articles

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Prognostic factors associated with failure of total elbow arthroplasty.

Hamoodi Z, Gehringer C, Bull L, Hughes T, Kearsley-Fleet L, Sergeant J Bone Joint Res. 2024; 13(5):201-213.

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Hamoodi Z, Gehringer C, Bull L, Hughes T, Kearsley-Fleet L, Sergeant J BMJ Open. 2023; 13(8):e071705.

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Comparison of baseline demographics and risk factors for aseptic loosening following primary total elbow arthroplasty.

Prior H, Jamil Z, Rodriguez A, Swiggett S, Weisberg M, Razi A Eur J Orthop Surg Traumatol. 2023; 33(7):3153-3158.

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Implant survival of total elbow arthroplasty: analysis of 514 cases from the Dutch Arthroplasty Registry.

Macken A, Prkic A, van Oost I, Spekenbrink-Spooren A, The B, Eygendaal D Bone Jt Open. 2023; 4(2):110-119.

PMID: 37051858 PMC: 9999123. DOI: 10.1302/2633-1462.42.BJO-2022-0152.R1.

References

Hanninen P, Niinimaki T, Flinkkila T, Niinimaki J, Ohtonen P, Yli-Luukko S . Discovery Elbow System: clinical and radiological results after 2- to 10-year follow-up. Eur J Orthop Surg Traumatol. 2017; 27(7):901-907. DOI: 10.1007/s00590-017-1954-4. View

Forster M, Clark D, Lunn P . Elbow osteoarthritis: prognostic indicators in ulnohumeral debridement--the Outerbridge-Kashiwagi procedure. J Shoulder Elbow Surg. 2001; 10(6):557-60. DOI: 10.1067/mse.2001.118416. View

Watkins C, Elson D, Harrison J, Pooley J . Long-term results of the lateral resurfacing elbow arthroplasty. Bone Joint J. 2018; 100-B(3):338-345. DOI: 10.1302/0301-620X.100B3.BJJ-2017-0865.R1. View

Nishida K, Hashizume K, Nakahara R, Ozawa M, Harada R, Machida T . Short-term results of the PROSNAP linked elbow prosthesis with a snap-in structure and modular flange for the reconstruction of severely damaged rheumatoid elbows. J Shoulder Elbow Surg. 2014; 23(6):837-42. DOI: 10.1016/j.jse.2013.12.031. View

Welsink C, Lambers K, van Deurzen D, Eygendaal D, van den Bekerom M . Total Elbow Arthroplasty: A Systematic Review. JBJS Rev. 2017; 5(7):e4. DOI: 10.2106/JBJS.RVW.16.00089. View

Little C, Graham A, Carr A . Total elbow arthroplasty: a systematic review of the literature in the English language until the end of 2003. J Bone Joint Surg Br. 2005; 87(4):437-44. DOI: 10.1302/0301-620X.87B4.15692. View

Robinson P, MacInnes S, Stanley D, Ali A . Heterotopic ossification following total elbow arthroplasty: a comparison of the incidence following elective and trauma surgery. Bone Joint J. 2018; 100-B(6):767-771. DOI: 10.1302/0301-620X.100B6.BJJ-2017-0535.R2. View

Wright T, Wong A, Jaffe R . Functional outcome comparison of semiconstrained and unconstrained total elbow arthroplasties. J Shoulder Elbow Surg. 2001; 9(6):524-31. DOI: 10.1067/mse.2000.109408. View

Sanchez-Sotelo J, Baghdadi Y, Morrey B . Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis: A Single-Institution Experience with 461 Elbows Over Three Decades. J Bone Joint Surg Am. 2016; 98(20):1741-1748. PMC: 5065309. DOI: 10.2106/JBJS.15.00649. View

10.

Toulemonde J, Ancelin D, Azoulay V, Bonnevialle N, Rongieres M, Mansat P . Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases. Int Orthop. 2015; 40(1):73-80. DOI: 10.1007/s00264-015-3008-z. View

11.

Brinkman J, de Vos M, Eygendaal D . Failure mechanisms in uncemented Kudo type 5 elbow prosthesis in patients with rheumatoid arthritis: 7 of 49 ulnar components revised because of loosening after 2-10 years. Acta Orthop. 2007; 78(2):263-70. DOI: 10.1080/17453670710013780. View

12.

van der Heide H, de Vos M, Brinkman J, Eygendaal D, van den Hoogen F, de Waal Malefijt M . Survivorship of the KUDO total elbow prosthesis--comparative study of cemented and uncemented ulnar components: 89 cases followed for an average of 6 years. Acta Orthop. 2007; 78(2):258-62. DOI: 10.1080/17453670710013771. View

13.

Prkic A, van Bergen C, The B, Eygendaal D . Total elbow arthroplasty is moving forward: Review on past, present and future. World J Orthop. 2016; 7(1):44-9. PMC: 4716570. DOI: 10.5312/wjo.v7.i1.44. View

14.

Goldberg S, Urban R, Jacobs J, King G, ODriscoll S, Cohen M . Modes of wear after semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2008; 90(3):609-19. DOI: 10.2106/JBJS.F.01286. View

15.

Celli A, Morrey B . Total elbow arthroplasty in patients forty years of age or less. J Bone Joint Surg Am. 2009; 91(6):1414-8. DOI: 10.2106/JBJS.G.00329. View

16.

Rauhaniemi J, Tiusanen H, Kyro A . Kudo total elbow arthroplasty in rheumatoid arthritis. Clinical and radiological results. J Hand Surg Br. 2005; 31(2):162-7. DOI: 10.1016/j.jhsb.2005.07.010. View

17.

Williams H, Madhusudhan T, Sinha A . Mid-term outcome of total elbow replacement for rheumatoid arthritis. J Orthop Surg (Hong Kong). 2016; 24(2):262-4. DOI: 10.1177/1602400228. View

18.

Kleinlugtenbelt I, Bakx P, Huij J . Instrumented Bone Preserving elbow prosthesis in rheumatoid arthritis: 2-8 year follow-up. J Shoulder Elbow Surg. 2010; 19(6):923-8. DOI: 10.1016/j.jse.2010.05.003. View

19.

Spinner R, Morgenlander J, Nunley J . Ulnar nerve function following total elbow arthroplasty: a prospective study comparing preoperative and postoperative clinical and electrophysiologic evaluation in patients with rheumatoid arthritis. J Hand Surg Am. 2000; 25(2):360-4. DOI: 10.1053/jhsu.2000.jhsu25a0360. View

20.

Celli A, Bonucci P . The anconeus-triceps lateral flap approach for total elbow arthroplasty in rheumatoid arthritis. Musculoskelet Surg. 2016; 100(Suppl 1):73-83. DOI: 10.1007/s12306-016-0417-0. View