Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old

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 IV Cite this article: Bone Jt Open 2023;4(1):19–26.

Recent advances in unlinked total elbow arthroplasty in Japan

“…During a mean follow-up period of 13.6 years, there were no revisions of implant removal and no radiological evidence of loosening around the components; they reported a 25-year survival rate of 78.1% with any revision surgery as the endpoint. 20 Kondo et al reported favorable long-term clinical results of the MNSK system in 75 patients, with a 5-year postoperative survival rate of 97% and a 10-year survival rate of 93%. While good long-term results have been achieved, complications are not uncommon.…”

Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis

“… 1 TJR can alleviate pain symptoms and improve joint function and quality of life in patients who have advanced rheumatoid arthritis (RA). 2 , 3 However, due to the immune dysfunction in RA patients and their use of disease-modifying antirheumatic drugs (DMARDs), 4 , 5 the infection rate after TJR in patients who have RA can be three-times higher than that in patients who have osteoarthritis (OA), with infection rates of 4.2% and 1.4%, 6 respectively. Indeed, RA is considered to be an independent risk factor for PJI.…”