SYNOVECTOMY OF THE ELBOW AND RADIAL HEAD EXCISION IN RHEUMATOID-ARTHRITIS - PREDICTIVE FACTORS AND LONG-TERM OUTCOME

We carried out a survival analysis of elbow synovectomy (ES) and excis ion of the radial head (RHE) performed on 171 rheumatoid elbows, The f ailure criteria were revision surgery (performed or desired) and/or th e presence of significant or severe pain. The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per y ear, The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compar ed, A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04). At review, there was a mean gain of 50 degrees in supination-p ronation and 11 degrees in flexion-extension; both correlated with suc cess. Failure correlated with recurrence of synovitis, elbow instabili ty, ulnar neuropathy, poor general mobility and poor upper-limb functi on, The last was independently affected by the severity of RA in the i psilateral shoulder. Our findings show that although the short-term re sult of ES and RHE in rheumatoid arthritis is good, the long-term outc ome is poor except in a subgroup with more than 50% limitation of fore arm rotation.