RESULTS OF TOTAL ELBOW ARTHROPLASTY AFTER EXCISION OF THE RADIAL HEADAND SYNOVECTOMY IN PATIENTS WHO HAD RHEUMATOID-ARTHRITIS

We compared the results of twenty-three consecutive capitellocondylar total elbow arthroplasties in twenty-three patients in whom an excisio n of the radial head and synovectomy for rheumatoid arthritis had fail ed with those of twenty-three non-consecutive primary capitellocondyla r total elbow arthroplasties in twenty-three patients who had rheumato id arthritis, The two groups were matched for age, gender, duration of follow-up, side of the operation, type of prosthesis, and operative a pproach, The average duration of follow-up was four years (range, two to fourteen years), At the most recent follow-up examination, use of a 100-point rating system demonstrated an improvement from an average p reoperative score of 21 points (range, 12 to 42 paints) to an average postoperative score of 87 points (range, 17 to 97 points) for the grou p in whom an excision of the radial head and synovectomy had failed, T he group that had primary arthroplasty demonstrated an improvement fro m an average preoperative score of 22 points (range, 7 to 42 points) t o an average postoperative score of 94 points (range, 85 to 100 points ), The group that had primary arthroplasty had a significantly greater improvement in terms of relief of pain (p < 0.05), functional status (p < 0.01), and the elbow-rating score (p < 0.03) than the other group , Four patients who had had failure of an excision of the radial head and synovectomy and none of those who had primary arthroplasty needed an additional operative procedure, Six of the patients who had had a f ailed excision and synovectomy and none of the patients who had primar y arthroplasty had instability of the elbow components. We concluded t hat, although excision of the radial head and synovectomy is a conserv ative and effective method of treating a painful rheumatoid elbow, con version to a capitellocondylar total elbow arthroplasty is more diffic ult after such an operation and the results at a minimum of two Sears are inferior to those for primary capitellocondylar total elbow arthro plasty.