Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

Purpose: Total elbow arthroplasty provides satisfactory results in most rheumatoid patients. Implant failure, uncommon during the first postoperative years, may increase thereafter. The purpose of this study was to analyze the long-term outcome of linked semiconstrained elbow arthroplasty in rheumatoid arthritis.

Material and Methods: From 1982 to 2006, 461 consecutive Coonrad-Morrey total elbow arthroplasties were implanted at our institution in rheumatoid elbows. There were 305 females and 82 males; 60 females and 14 males had both elbows replaced. Their mean age was 64 (range, 28 to 88) years. In the first 2 postoperative years, 9 patients died (10 elbows), 12 were lost, and 7 prostheses were revised or removed. The remaining 432 arthroplasties were followed for a mean of 8 (range, 2 to 25) years.

Results: At most recent follow-up, 418 implants (90.7%) had not been revised, 10 (2.2%) had been removed or revised for infection, 25 (5.4%) had been revised for loosening of the ulnar component (21), humeral component (3) or both (1), 8 elbows (1.7%) had been revised for isolated polyethylene wear, and 3 patients underwent internal fixation of a periprosthetic fracture around well-fixed components. Seventeen additional elbows required debridement with component retention for deep infection (overall deep infection rate, 5.8%). Thirteen of the 22 ulnar components revised for loosening were precoated with polymethylmethacrylate. Revision for isolated polyethylene wear was performed between 10 and 17 years after surgery in all but one of the eight elbows. Twenty-year survivoships were 90% (95CI 79-94%) free of revision for loosening, 78% (95CI 65-89%) free of revision for mechanical failure, and 72% (95CI 58-85) free of revision for mechanical failure of deep infection.

Conclusion:  Linked semiconstrained total elbow arthroplasty provides satisfactory outcomes and a relatively low failure rate in rheumatoid arthritis. Infection and ulnar component loosening were the main reasons for failure with this particular implant.