ABSTRACT
AIMS:
There are concerns regarding
complications and
longevity of total
elbow arthroplasty (
TEA) in young
patients, and the few previous
publications are mainly limited to
reports on linked
elbow devices. We investigated the clinical outcome of unlinked
TEA for
patients aged less than 50 years with
rheumatoid arthritis (RA).
METHODS:
We retrospectively reviewed the
records of 26 elbows of 21
patients with RA
who were
aged less than 50 years
who underwent primary
TEA with an unlinked
elbow prosthesis. The mean
patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27).
Outcome measures included
pain,
range of motion, Mayo
Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening,
complications, and
revision surgery with or without implant removal.
RESULTS:
The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001).
Complications were noted in six elbows (23%) in six
patients, and of these, four with an
ulnar neuropathy and one
elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any
revision surgery as the endpoint, the
survival rates up to 25 years were 78.1% (95%
confidence interval 52.8 to 90.6) as determined by
Kaplan-Meier analysis.
CONCLUSION:
The clinical outcome of primary unlinked
TEA for young
patients with RA was satisfactory and comparable with that for
elderly patients. A favourable
survival rate without implant removal might support the use of unlinked
devices for young
patients with this
disease entity, with a caution of a relatively high complication rate regarding
ulnar neuropathy.Level of Evidence
Therapeutic Level IVCite this article
Bone Jt Open 2023;4(1)19-26.
