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Bernard F Morrey - One of the best experts on this subject based on the ideXlab platform.
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primary linked semiconstrained total elbow arthroplasty for rheumatoid arthritis a single institution experience with 461 Elbows over three decades
Journal of Bone and Joint Surgery American Volume, 2016Co-Authors: Joaquin Sanchezsotelo, Yaser M K Baghdadi, Bernard F MorreyAbstract:Background: Elbow arthroplasty is the treatment of choice for end-stage rheumatoid arthritis (RA). The purpose of this study was to determine the long-term outcome of a linked semiconstrained elbow arthroplasty implant design in patients with RA. Methods: Between 1982 and 2006, 461 primary total elbow arthroplasties using the Coonrad-Morrey prosthesis were performed in 387 patients with RA. Fifty-five of the arthroplasties were performed to treat concurrent traumatic or posttraumatic conditions. There were 305 women (365 Elbows, 79%) and 82 men (96 Elbows, 21%). Ten patients (10 Elbows) were lost to follow-up, 9 patients (10 Elbows) died, and 6 patients (6 Elbows) underwent revision surgery within the first 2 years. For the 435 Elbows (362 patients, 94%) with a minimum of 2 years of follow-up, the median follow-up was 10 years (range, 2 to 30 years). Results: At the most recent follow-up, 49 (11%) of the Elbows had undergone component revision or removal (deep infection, 10 Elbows; and mechanical failure, 39 Elbows). Eight additional Elbows were considered to have radiographic evidence of loosening. For surviving implants followed for a minimum of 2 years, the median Mayo Elbow Performance Score (MEPS) was 90 points. Bushing wear was identified in 71 (23%) of the surviving Elbows with a minimum of 2 years of radiographic follow-up; however, only 2% of the Elbows had been revised for isolated bushing wear. The rate of survivorship free of implant revision or removal for any reason was 92% (95% confidence interval [CI] = 88% to 94%) at 10 years, 83% (95% CI = 77% to 88%) at 15 years, and 68% (95% CI = 56% to 78%) at 20 years. The survivorship at 20 years was 88% (95% CI = 83% to 92%) with revision due to aseptic loosening as the end point and 89% (95% CI = 77% to 95%) with isolated bushing exchange as the end point. Risk factors for implant revision for any cause included male sex, a history of concomitant traumatic pathology, and implantation of an ulnar component with a polymethylmethacrylate surface finish. Conclusions: Elbow arthroplasty using a cemented linked semiconstrained elbow arthroplasty provides satisfactory clinical results in the treatment of RA with a reasonable rate of survivorship free of mechanical failure at 20 years. Although bushing wear was identified on radiographs in approximately one-fourth of the patients, revision for isolated bushing wear was uncommon. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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the outcome of total elbow arthroplasty in juvenile idiopathic arthritis juvenile rheumatoid arthritis patients
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Yaser M K Baghdadi, Bernard F Morrey, Justin A Jacobson, Thomas R Duquin, Dirk R Larson, Joaquin SanchezsoteloAbstract:Background Elbow prosthetic replacement in patients with juvenile idiopathic arthritis (JIA) can be complicated and technically challenging. Thus, we sought to evaluate the clinical benefit and the prosthetic longevity of primary semiconstrained linked total elbow arthroplasty (TEA) performed to treat these patients. Methods Between 1983 and 2005, 29 Elbows in 24 patients (20 women and 4 men) had been replaced because of JIA. The mean age was 37 years (range, 24-68 years). Because of underlying deformity, the implant contour was modified for 9 Elbows (31%) and a customized implant was inserted in 5 Elbows (17%). The mean follow-up duration was 10.5 years (range, 4.6-20.1 years). Results During the follow-up period, 8 Elbows underwent reoperation, including 6 (21%) that underwent implant revision. At most recent follow-up, 22 Elbows (76%) subjectively had a satisfactory overall functional result. The mean Mayo Elbow Performance Score was 78 points (range, 50-100 points), with 18 Elbows graded as having an excellent or good result. Compared with preoperative range of motion, the mean extension-flexion arc improved from 65° ± 44° to 89° ± 35° ( P = .01), mean flexion improved from 113° ± 23° to 126° ± 26° ( P = .02), and mean extension improved from 48° ± 25° to 37° ± 26° ( P = .08). By use of the Kaplan-Meier survivorship method, the rate of TEA survival from any revision was 96.4% (95% confidence interval, 89.8%-100%) and 79.9% (95% confidence interval, 65.1%-97.5%) at 5 years and 10 years, respectively. Conclusion Primary TEA for JIA patients is technically challenging and frequently requires implant modification or custom designs. These patients might have high complication and revision rates. However, most benefit from the intervention for a long term.
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Anconeus Interposition Arthroplasty: Mid- to Long-term Results
Clinical Orthopaedics and Related Research®, 2014Co-Authors: Yaser M K Baghdadi, Bernard F Morrey, Joaquin Sanchez-soteloAbstract:Background Radiocapitellar arthritis and/or proximal radioulnar impingement can be difficult to treat. Interposition of the anconeus muscle has been described in the past as an alternative option in managing arthritis, but there are little published data about relief of pain and restoration of function over the long term in patients treated with this approach. Questions/purposes We sought (1) to determine whether interposition of the anconeus muscle in the radiocapitellar and/or proximal radioulnar joint relieves pain and restores elbow function; and (2) to identify complications and reoperations after anconeus interposition arthroplasty. Methods Between 1992 and 2012, we surgically treated 39 patients having radiocapitellar arthritis and/or proximal radioulnar impingement with an anconeus interposition arthroplasty. These were performed for situations in which capitellar and/or radial head pathology was deemed not amenable to implant replacement. We had complete followup on 29 of them (74%) at a minimum of 1 year (mean, 10 years; range, 1–20 years). These 29 patients (21 males, eight females) had interposition of the anconeus muscle at the radiocapitellar joint (10 Elbows), the proximal radioulnar joint (two Elbows), or both (17 Elbows). Their mean age at the time of surgery was 39 years (range, 14–58 years). The reasons for the previous determination or the indications included lateral-side elbow symptoms after radial head resection (eight Elbows), failed internal fixation of radial head fracture (two Elbows), failed radial head replacement with or without capitellar replacement (four Elbows), osteoarthritis and Essex-Lopresti injury (six Elbows), failed internal fixation of distal humeral fracture involving the capitellum (two Elbows), posttraumatic osteoarthritis involving the lateral compartment (one elbow), lateral compartment osteoarthritis associated with chondropathies (three Elbows), and primary osteoarthritis affecting the lateral compartment (three Elbows). Patient-reported outcome tools included the quick-Disabilities of the Arm, Shoulder and Hand (quick-DASH) and the Mayo Elbow Performance Score (MEPS); we also performed a chart review for complications and reoperations. Results During the followup duration, the mean MEPS was significantly improved from (mean ± SD) 64 ± 17 points before surgery to 82 ± 14 points after surgery (p
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Total elbow replacement for the management of the ankylosed or fused elbow
The Journal of bone and joint surgery. British volume, 2008Co-Authors: J P Peden, Bernard F MorreyAbstract:This study reports our experience with total elbow replacement for fused Elbows. Between 1982 and 2004, 13 patients with spontaneously ankylosed Elbows were treated with a linked semi-constrained non-custom total elbow implant. The mean age at operation was 54 years (24 to 80). The stiffness was a result of trauma in ten Elbows, juvenile rheumatoid arthritis in one, and rheumatoid arthritis in two. The patients were followed for a mean of 12 years (2 to 26) and were evaluated clinically using the Mayo Elbow Performance Score, as well as radiologically. A mean arc from 37 degrees of extension to 118 degrees of flexion was achieved. Outcomes were good or excellent for seven Elbows at final review. Ten patients felt better or much better after total elbow replacement. However, there was a high complication rate and re-operation was required in over half of patients. Two developed peri-operative soft-tissue breakdown requiring debridement. A muscle flap with skin grafting was used for soft-tissue cover in one. Revision was undertaken in one elbow following fracture of the ulnar component. Three patients developed a deep infection. Three Elbows were manipulated under anaesthesia for post-operative stiffness. Prophylactic measures for heterotopic ossification were unsuccessful. Total elbow replacement for the ankylosed elbow should be performed with caution. However, the outcome can be reliable in the long term and have a markedly positive impact on patient function and satisfaction. The high potential for complications must be considered. We consider total elbow replacement to be an acceptable procedure in selected patients with reasonable expectations.
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fracture and nonunion of the olecranon in total elbow arthroplasty
Journal of Shoulder and Elbow Surgery, 2006Co-Authors: Guido Marra, Bernard F Morrey, Stephen H Gallay, Michael D Mckee, Shawn W OdriscollAbstract:Background: While fracture and nonunion of the olecranon have been reported in patients undergoing total elbow arthroplasty, little information exists about the management and outcome of these cases. Methods: Twenty-four patients (twenty-five Elbows) were studied; fifteen (sixteen Elbows) with rheumatoid arthritis and nine with post-traumatic elbow disorders. Twenty-three of the twenty-five Elbows presented with an olecranon fracture or nonunion prior to the reported arthroplasty. During arthroplasty the olecranon fragment was initially treated by tension band in sixteen Elbows, excision in four, suture fixation in two and three with stable fibrous union were left alone. Results: At an average follow-up of 66 months (range, 18 to 242), there were twelve excellent, nine good, three fair and one poor results. The mean pre-operative Mayo Elbow Performance Score improved from 42 (range, 20 to 62) points pre-operatively to 86 (range, 50 to 100) points post-operatively (p
Cunyi Fan - One of the best experts on this subject based on the ideXlab platform.
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Validation of the Liverpool Elbow Score for evaluation of elbow stiffness.
BMC musculoskeletal disorders, 2018Co-Authors: Ziyang Sun, Cunyi FanAbstract:Background The Liverpool Elbow Score (LES) has been widely used to assess the outcomes of total elbow replacement in various conditions. However, there have been no published validation studies on LES for patients with stiff Elbows undergoing arthrolysis. The purpose of this study was to find out whether LES could be equally applied to evaluate joint function in patients with elbow stiffness.
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application of distal radius positioned hinged external fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Shuai Chen, Yi Zhou, Wei Wang, Jiangyu Cai, Shen Liu, Cunyi FanAbstract:Background Radical release for severe stiff Elbows may lead to instability. Hinged external fixation is used to treat unstable Elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic Elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged external fixator is an effective treatment for severe stiff Elbows. This technique had a low complication rate.
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stability of severely stiff Elbows after complete open release treatment by ligament repair with suture anchors and hinged external fixator
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Wei Wang, Shen Liu, Shichao Jiang, Hongjiang Ruan, Cunyi FanAbstract:Background Instability is a crucial issue in severe post-traumatic elbow stiffness during complete-release surgery. This study aimed to evaluate the efficacy of ligament repair using a suture anchor in the operative treatment of severely stiff Elbows for which a hinged external fixator was indicated. Methods We retrospectively reviewed 46 cases of severely stiff Elbows (flexion arc Results At a mean follow-up of 24.3 months, the postoperative Mayo Elbow Performance Score was 91 points, as compared with 63 points preoperatively. The mean flexion arc improved from 25° to 126°. Three patients presented with moderate elbow instability when the hinged external fixator was removed; however, all of them regained stability by the last follow-up. Furthermore, 7 cases of new-onset nerve palsy were noted; however, all of them resolved with conservative management. None of the patients required secondary surgery for any reason. Conclusions Repair of an avulsed collateral ligament with suture anchors and hinged external fixation was effective in restoring functional mobility in patients with severe post-traumatic elbow stiffness after complete release. This could be an option for treating ankylosed, severely or very severely stiff Elbows.
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open arthrolysis and hinged external fixation for posttraumatic ankylosed Elbows
Archives of Orthopaedic and Trauma Surgery, 2013Co-Authors: Hongjiang Ruan, Shen Liu, Cunyi Fan, Junjian LiuAbstract:An ankylosed elbow is defined as an elbow having a range of motion of 0°. Movement is extremely limited. This study retrospectively analyzes the results of arthrolysis and hinged external fixation performed on 15 patients suffering from ankylosed Elbows. Fifteen completely ankylosed Elbows were treated by arthrolysis and hinged external fixation. Patients comprised nine men and six women, with a mean age of 37.93 years (37.93 ± 9.68) when arthrolysis was performed. Before surgery, the Elbows were ankylosed at various angles ranging from 30° to 85°. Eleven patients underwent arthrolysis by medial and lateral approaches, three patients by the posterior approach, and one patient by posterior and lateral approaches. Hinged external fixators were applied to all patients. Subcutaneous anterior transposition of the ulnar nerve was performed in all patients. All patients received satisfactory follow-up. The range of motion of the elbow improved from 0° preoperatively to a postoperative mean of 115.67° (115.67 ± 23.29). The Mayo Elbow Performance Score improved from a mean of 67.67 ± 11.00 to 86.67 ± 8.38 points, with excellent results in nine patients, good in five, and fair in one. This difference is statistically significant (t = −6.862; p < 0.001). Open arthrolysis and monolateral hinged external fixation are effective in treating posttraumatic ankylosed elbow. Arthrolysis should be performed by a combination of lateral and medial approaches. In addition, routine hinged external fixation and anterior transposition of the ulnar nerve may improve the postoperative recovery of elbow stiffness.
Wei Wang - One of the best experts on this subject based on the ideXlab platform.
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Application of distal radius–positioned hinged external fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Yi Zhou, Shuai Chen, Wei WangAbstract:Background Radical release for severe stiff Elbows may lead to instability. Hinged external fixation is used to treat unstable Elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic Elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged external fixator is an effective treatment for severe stiff Elbows. This technique had a low complication rate.
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application of distal radius positioned hinged external fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Shuai Chen, Yi Zhou, Wei Wang, Jiangyu Cai, Shen Liu, Cunyi FanAbstract:Background Radical release for severe stiff Elbows may lead to instability. Hinged external fixation is used to treat unstable Elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic Elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged external fixator is an effective treatment for severe stiff Elbows. This technique had a low complication rate.
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stability of severely stiff Elbows after complete open release treatment by ligament repair with suture anchors and hinged external fixator
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Wei Wang, Shen Liu, Shichao Jiang, Hongjiang Ruan, Cunyi FanAbstract:Background Instability is a crucial issue in severe post-traumatic elbow stiffness during complete-release surgery. This study aimed to evaluate the efficacy of ligament repair using a suture anchor in the operative treatment of severely stiff Elbows for which a hinged external fixator was indicated. Methods We retrospectively reviewed 46 cases of severely stiff Elbows (flexion arc Results At a mean follow-up of 24.3 months, the postoperative Mayo Elbow Performance Score was 91 points, as compared with 63 points preoperatively. The mean flexion arc improved from 25° to 126°. Three patients presented with moderate elbow instability when the hinged external fixator was removed; however, all of them regained stability by the last follow-up. Furthermore, 7 cases of new-onset nerve palsy were noted; however, all of them resolved with conservative management. None of the patients required secondary surgery for any reason. Conclusions Repair of an avulsed collateral ligament with suture anchors and hinged external fixation was effective in restoring functional mobility in patients with severe post-traumatic elbow stiffness after complete release. This could be an option for treating ankylosed, severely or very severely stiff Elbows.
Yi Zhou - One of the best experts on this subject based on the ideXlab platform.
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Application of distal radius–positioned hinged external fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Yi Zhou, Shuai Chen, Wei WangAbstract:Background Radical release for severe stiff Elbows may lead to instability. Hinged external fixation is used to treat unstable Elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic Elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged external fixator is an effective treatment for severe stiff Elbows. This technique had a low complication rate.
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application of distal radius positioned hinged external fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Shuai Chen, Yi Zhou, Wei Wang, Jiangyu Cai, Shen Liu, Cunyi FanAbstract:Background Radical release for severe stiff Elbows may lead to instability. Hinged external fixation is used to treat unstable Elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged external fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic Elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged external fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged external fixator is an effective treatment for severe stiff Elbows. This technique had a low complication rate.
Yaser M K Baghdadi - One of the best experts on this subject based on the ideXlab platform.
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primary linked semiconstrained total elbow arthroplasty for rheumatoid arthritis a single institution experience with 461 Elbows over three decades
Journal of Bone and Joint Surgery American Volume, 2016Co-Authors: Joaquin Sanchezsotelo, Yaser M K Baghdadi, Bernard F MorreyAbstract:Background: Elbow arthroplasty is the treatment of choice for end-stage rheumatoid arthritis (RA). The purpose of this study was to determine the long-term outcome of a linked semiconstrained elbow arthroplasty implant design in patients with RA. Methods: Between 1982 and 2006, 461 primary total elbow arthroplasties using the Coonrad-Morrey prosthesis were performed in 387 patients with RA. Fifty-five of the arthroplasties were performed to treat concurrent traumatic or posttraumatic conditions. There were 305 women (365 Elbows, 79%) and 82 men (96 Elbows, 21%). Ten patients (10 Elbows) were lost to follow-up, 9 patients (10 Elbows) died, and 6 patients (6 Elbows) underwent revision surgery within the first 2 years. For the 435 Elbows (362 patients, 94%) with a minimum of 2 years of follow-up, the median follow-up was 10 years (range, 2 to 30 years). Results: At the most recent follow-up, 49 (11%) of the Elbows had undergone component revision or removal (deep infection, 10 Elbows; and mechanical failure, 39 Elbows). Eight additional Elbows were considered to have radiographic evidence of loosening. For surviving implants followed for a minimum of 2 years, the median Mayo Elbow Performance Score (MEPS) was 90 points. Bushing wear was identified in 71 (23%) of the surviving Elbows with a minimum of 2 years of radiographic follow-up; however, only 2% of the Elbows had been revised for isolated bushing wear. The rate of survivorship free of implant revision or removal for any reason was 92% (95% confidence interval [CI] = 88% to 94%) at 10 years, 83% (95% CI = 77% to 88%) at 15 years, and 68% (95% CI = 56% to 78%) at 20 years. The survivorship at 20 years was 88% (95% CI = 83% to 92%) with revision due to aseptic loosening as the end point and 89% (95% CI = 77% to 95%) with isolated bushing exchange as the end point. Risk factors for implant revision for any cause included male sex, a history of concomitant traumatic pathology, and implantation of an ulnar component with a polymethylmethacrylate surface finish. Conclusions: Elbow arthroplasty using a cemented linked semiconstrained elbow arthroplasty provides satisfactory clinical results in the treatment of RA with a reasonable rate of survivorship free of mechanical failure at 20 years. Although bushing wear was identified on radiographs in approximately one-fourth of the patients, revision for isolated bushing wear was uncommon. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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the outcome of total elbow arthroplasty in juvenile idiopathic arthritis juvenile rheumatoid arthritis patients
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Yaser M K Baghdadi, Bernard F Morrey, Justin A Jacobson, Thomas R Duquin, Dirk R Larson, Joaquin SanchezsoteloAbstract:Background Elbow prosthetic replacement in patients with juvenile idiopathic arthritis (JIA) can be complicated and technically challenging. Thus, we sought to evaluate the clinical benefit and the prosthetic longevity of primary semiconstrained linked total elbow arthroplasty (TEA) performed to treat these patients. Methods Between 1983 and 2005, 29 Elbows in 24 patients (20 women and 4 men) had been replaced because of JIA. The mean age was 37 years (range, 24-68 years). Because of underlying deformity, the implant contour was modified for 9 Elbows (31%) and a customized implant was inserted in 5 Elbows (17%). The mean follow-up duration was 10.5 years (range, 4.6-20.1 years). Results During the follow-up period, 8 Elbows underwent reoperation, including 6 (21%) that underwent implant revision. At most recent follow-up, 22 Elbows (76%) subjectively had a satisfactory overall functional result. The mean Mayo Elbow Performance Score was 78 points (range, 50-100 points), with 18 Elbows graded as having an excellent or good result. Compared with preoperative range of motion, the mean extension-flexion arc improved from 65° ± 44° to 89° ± 35° ( P = .01), mean flexion improved from 113° ± 23° to 126° ± 26° ( P = .02), and mean extension improved from 48° ± 25° to 37° ± 26° ( P = .08). By use of the Kaplan-Meier survivorship method, the rate of TEA survival from any revision was 96.4% (95% confidence interval, 89.8%-100%) and 79.9% (95% confidence interval, 65.1%-97.5%) at 5 years and 10 years, respectively. Conclusion Primary TEA for JIA patients is technically challenging and frequently requires implant modification or custom designs. These patients might have high complication and revision rates. However, most benefit from the intervention for a long term.
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Anconeus Interposition Arthroplasty: Mid- to Long-term Results
Clinical Orthopaedics and Related Research®, 2014Co-Authors: Yaser M K Baghdadi, Bernard F Morrey, Joaquin Sanchez-soteloAbstract:Background Radiocapitellar arthritis and/or proximal radioulnar impingement can be difficult to treat. Interposition of the anconeus muscle has been described in the past as an alternative option in managing arthritis, but there are little published data about relief of pain and restoration of function over the long term in patients treated with this approach. Questions/purposes We sought (1) to determine whether interposition of the anconeus muscle in the radiocapitellar and/or proximal radioulnar joint relieves pain and restores elbow function; and (2) to identify complications and reoperations after anconeus interposition arthroplasty. Methods Between 1992 and 2012, we surgically treated 39 patients having radiocapitellar arthritis and/or proximal radioulnar impingement with an anconeus interposition arthroplasty. These were performed for situations in which capitellar and/or radial head pathology was deemed not amenable to implant replacement. We had complete followup on 29 of them (74%) at a minimum of 1 year (mean, 10 years; range, 1–20 years). These 29 patients (21 males, eight females) had interposition of the anconeus muscle at the radiocapitellar joint (10 Elbows), the proximal radioulnar joint (two Elbows), or both (17 Elbows). Their mean age at the time of surgery was 39 years (range, 14–58 years). The reasons for the previous determination or the indications included lateral-side elbow symptoms after radial head resection (eight Elbows), failed internal fixation of radial head fracture (two Elbows), failed radial head replacement with or without capitellar replacement (four Elbows), osteoarthritis and Essex-Lopresti injury (six Elbows), failed internal fixation of distal humeral fracture involving the capitellum (two Elbows), posttraumatic osteoarthritis involving the lateral compartment (one elbow), lateral compartment osteoarthritis associated with chondropathies (three Elbows), and primary osteoarthritis affecting the lateral compartment (three Elbows). Patient-reported outcome tools included the quick-Disabilities of the Arm, Shoulder and Hand (quick-DASH) and the Mayo Elbow Performance Score (MEPS); we also performed a chart review for complications and reoperations. Results During the followup duration, the mean MEPS was significantly improved from (mean ± SD) 64 ± 17 points before surgery to 82 ± 14 points after surgery (p