Synovectomy of the elbow and radial head excision in rheumatoid arthritis. Predictive factors and long-term outcome
| Autor: | N S, Gendi, J M, Axon, A J, Carr, K D, Pile, P D, Burge, A G, Mowat |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Joint Instability Male Reoperation Supination Arthritis Rheumatoid Recurrence Synovectomy Elbow Joint Humans Pronation Longitudinal Studies Treatment Failure Range of Motion Articular Ulnar Nerve Aged Retrospective Studies Aged 80 and over Pain Postoperative Synovitis Shoulder Joint Peripheral Nervous System Diseases Middle Aged Survival Analysis Osteotomy Radius Treatment Outcome Arm Female Follow-Up Studies Forecasting |
| Zdroj: | The Journal of bone and joint surgery. British volume. 79(6) |
| ISSN: | 0301-620X |
| Popis: | We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were revision surgery (performed or desired) and/or the presence of significant or severe pain. The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per year. The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compared. A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04). At review, there was a mean gain of 50 degrees in supination-pronation and 11 degrees in flexion-extension; both correlated with success. Failure correlated with recurrence of synovitis, elbow instability, ulnar neuropathy, poor general mobility and poor upper-limb function. The last was independently affected by the severity of RA in the ipsilateral shoulder. Our findings show that although the short-term result of ES and RHE in rheumatoid arthritis is good, the long-term outcome is poor except in a subgroup with more than 50% limitation of forearm rotation. |
| Databáze: | OpenAIRE |
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