TOTAL ELBOW ARTHROPLASTY IN PATIENTS WHO HAVE JUVENILE RHEUMATOID-ARTHRITIS

Patients who have juvenile rheumatoid arthritis often are seen at a ve ry young age because of severe stiffness and pain in several joints. W hile total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft t issues and the extremely small bones and intramedullary cavities in th ese patients. As there is little information in the literature regardi ng this procedure, we attempted to learn about the long-term results b y evaluating nineteen patients (twenty-four elbows) with juvenile rheu matoid arthritis who had been managed with total elbow arthroplasty. A t an average of 7.4 years (range, two to fourteen years) after the ope ration, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 poi nts (range, 55 to 100 points). Twenty-two (96 per Cent) of the twenty- three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average are of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperativ e are of flexion began at 35 degrees, with additional flexion to 125 d egrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average are of 73 degrees after the operatio n, and evaluation of the twenty ipsilateral wrists that were not limit ed by disease revealed that pronation and supination had been maintain ed. The average functional score improved from 9 points (range, 0 to 2 5 points) preoperatively to 23 points (range, 15 to 25 points) postope ratively (p < 0.001), The function of eighteen elbows (78 per cent) di d not adversely affect the ability to perform activities of daily livi ng. There were thirteen complications, including one perioperative dea th, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxatio n of the prosthesis, stiffness of the elbow, and problems with wound-h ealing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatmen t. Late complications (aseptic loosening, instability, and worn bushin gs) led to three poor results. None of the eighteen semiconstrained pr ostheses had radiographic evidence of loosening at the most recent fol low-up: evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a p oor result.