Abstract
Background
Very few longer term follow-up of unlinked elbow replacements have been published and most series are small.
Methods
Since 1994 87 Kudo 5 total elbow replacements in 70 patients were undertaken by two specialist elbow surgeons (LN and MT) for adult rheumatoid arthritis. These were evaluated at a mean follow-up of 79 months (29 months to 137 months) using the Mayo Clinic performance index. Post-operative radiographs were also reviewed for loosening using standard antero-posterior and lateral films.
Results
Eight patients were lost to follow-up and 16 patients had died leaving 62 total elbow replacements in 46 patients. Pre-operatively 6 had moderate pain and 56 had severe pain. Post-operatively the pain was rated as none by 58 and moderate by 4. The average Mayo elbow score improved from 37 pre-operatively to 86 post-operatively. The flexion extension arc improved from 60? to 99?, whilst pronation and supination improved by 18? and 20? respectively. The overall complication rate was 24% with ulnar neuropraxia being the commonest problem. Six cases were revised, four for aseptic loosening and two for sepsis. The ulnar component was the more commonly affected and appeared to be the cause of more problems. However with revision as the endpoint, the probability of survival of the Kudo 5 at 79 months using the Kaplan Meier method was 96% reducing to 86% at 100 months.
Conclusion
The results of the Kudo 5 total elbow replacement in patients with adult rheumatoid arthritis are acceptable and comparable with other reported series and to other unlinked implants with similar follow-up.
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