A comparison of different prostheses used in total elbow arthroplasty has shown that, despite patient satisfaction, the implants only slightly improve range of motion.
Total elbow arthroplasty is primarily carried out in arthritis patients to relieve pain rather than to improve range of motion or stability.
The evolution of implants for the procedure has gone from hinged devices commonly associated with early aseptic loosening to a variety of advanced models that require revision in only 9% of cases 5 years after being implanted.
However, Eerik Skyttä (Helsinki University Central Hospital, Hus, Finland) and colleagues note: "There are only limited published data guiding the clinician in the choice of implant and up to the present day, only six papers that compared the performances of different implants have been published, and only three of those deal with contemporary implants."
In this study, the investigators recruited 21 consecutive patients with rheumatoid arthritis (RA) and severe joint destruction who had undergone a Souter-Strathclyde total elbow arthroplasty and a further 21 individuals with the same symptoms who had a Kudo device implanted during arthroplasty. All procedures were carried out between 1988 and 1998.
Overall, six revisions were necessary. In four cases this was due to aseptic loosening while one patient experienced fracture and one required a revision because of excessive wear on the implant liner and metallosis.
Taking these revisions into account, the Souter-Strathclyde implant and the Kudo device had comparable 5-year survival rates of 85% and 95%, respectively.
The implants generally served their primary aim and patients reported that their pain was moderately frequent, usually mild, and that they were generally happy with the implant.
This was despite the fact that over 50% of patients could perform only light housekeeping tasks, and that 83% of those with a Kudo implant and 56% of those with a Souter-Strathclyde device could not maintain personal hygiene, defined as the ability to move the hand to the perineum.
Based on the results, published in the Archives of Orthopaedic and Trauma Surgery, the authors say: "Total elbow arthroplasty provides good pain relief for the arthritic elbow leading to high patient satisfaction despite the residual disabilities."