Primary Linked Semiconstrained Total Elbow Arthroplasty for Rheumatoid Arthritis
Autor: | Yaser M. K. Baghdadi, Bernard F. Morrey, Joaquin Sanchez-Sotelo |
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Rok vydání: | 2016 |
Předmět: |
Male
Reoperation musculoskeletal diseases Scientific Articles medicine.medical_specialty Joint Prosthesis medicine.medical_treatment Elbow Prosthesis Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Survivorship curve Elbow Joint Humans Medicine Orthopedics and Sports Medicine Range of Motion Articular Aged 030222 orthopedics business.industry Arthroplasty Replacement Elbow 030229 sport sciences General Medicine Middle Aged musculoskeletal system medicine.disease Arthroplasty Surgery body regions Treatment Outcome medicine.anatomical_structure Rheumatoid arthritis Concomitant Female Implant business Range of motion Follow-Up Studies |
Zdroj: | Journal of Bone and Joint Surgery. 98:1741-1748 |
ISSN: | 1535-1386 0021-9355 |
Popis: | Background Elbow arthroplasty is the treatment of choice for end-stage rheumatoid arthritis (RA). The purpose of this study was to determine the long-term outcome of a linked semiconstrained elbow arthroplasty implant design in patients with RA. Methods Between 1982 and 2006, 461 primary total elbow arthroplasties using the Coonrad-Morrey prosthesis were performed in 387 patients with RA. Fifty-five of the arthroplasties were performed to treat concurrent traumatic or posttraumatic conditions. There were 305 women (365 elbows, 79%) and 82 men (96 elbows, 21%). Ten patients (10 elbows) were lost to follow-up, 9 patients (10 elbows) died, and 6 patients (6 elbows) underwent revision surgery within the first 2 years. For the 435 elbows (362 patients, 94%) with a minimum of 2 years of follow-up, the median follow-up was 10 years (range, 2 to 30 years). Results At the most recent follow-up, 49 (11%) of the elbows had undergone component revision or removal (deep infection, 10 elbows; and mechanical failure, 39 elbows). Eight additional elbows were considered to have radiographic evidence of loosening. For surviving implants followed for a minimum of 2 years, the median Mayo Elbow Performance Score (MEPS) was 90 points. Bushing wear was identified in 71 (23%) of the surviving elbows with a minimum of 2 years of radiographic follow-up; however, only 2% of the elbows had been revised for isolated bushing wear. The rate of survivorship free of implant revision or removal for any reason was 92% (95% confidence interval [CI] = 88% to 94%) at 10 years, 83% (95% CI = 77% to 88%) at 15 years, and 68% (95% CI = 56% to 78%) at 20 years. The survivorship at 20 years was 88% (95% CI = 83% to 92%) with revision due to aseptic loosening as the end point and 89% (95% CI = 77% to 95%) with isolated bushing exchange as the end point. Risk factors for implant revision for any cause included male sex, a history of concomitant traumatic pathology, and implantation of an ulnar component with a polymethylmethacrylate surface finish. Conclusions Elbow arthroplasty using a cemented linked semiconstrained elbow arthroplasty provides satisfactory clinical results in the treatment of RA with a reasonable rate of survivorship free of mechanical failure at 20 years. Although bushing wear was identified on radiographs in approximately one-fourth of the patients, revision for isolated bushing wear was uncommon. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
Databáze: | OpenAIRE |
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