CAPITELLOCONDYLAR TOTAL ELBOW REPLACEMENT IN RHEUMATOID-ARTHRITIS - LONG-TERM RESULTS

We evaluated the long-term results of 202 capitellocondylar total elbo w replacements that had been performed, from July 1974 through June 19 87, in 172 patients. The duration of follow-up averaged sixty-nine mon ths (range, twenty-four to 178 months). At the most recent follow-up e xamination, use of a 100-point rating score demonstrated an improvemen t from an average preoperative score of 26 points (range, 2 to 50 poin ts) to an average postoperative score of 91 points (range, 45 to 100 p oints). The most improvement occurred in the categories of relief of p ain, functional status, and range of motion in all planes except exten sion. The improvements in these categories and in the roentgenographic appearance that were seen in the early postoperative period did not d eteriorate with time. The average preoperative arc of motion at the el bow ranged from -37 degrees of extension to 118 degrees of flexion. Th e average postoperative arc of motion at the elbow ranged from -30 deg rees of extension to 135 degrees of flexion. Supination improved from 45 degrees preoperatively to 64 degrees postoperatively; pronation imp roved from 56 degrees preoperatively to 72 degrees postoperatively. Th e roentgenograms showed a radiolucent line adjacent to eight humeral a nd nineteen ulnar components; most of the lines were incomplete and on e millimeter wide or less. Revision of the prosthesis was necessary in three elbows (1.5 per cent) because of loosening without infection, a nd in three additional elbows because of dislocation of the prosthesis . Complications included deep infection in three elbows (1.5 per cent) ; problems related to the wound in fifteen (7 per cent); permanent, pa rtial sensory ulnar-nerve palsy in five (2.5 per cent); permanent, par tial motor ulnar-nerve palsy in one (0.5 per cent); and dislocation in seven (3.5 per cent).