Brinkman Justus-Martijn, de Vos Maarten J, Eygendaal Denise
Department of Orthopedics, Sint Maartenskliniek. Nijmegen, The Netherlands.
Acta Orthop. 2007 Apr;78(2):263-70. doi: 10.1080/17453670710013780.
Both components of the Kudo type 5 elbow prosthesis can be inserted with or without the use of cement. There have been no reports on the use of this prosthesis with all components uncemented in patients with rheumatoid arthritis.
We reviewed 49 primary uncemented Kudo type 5 elbow prostheses, inserted in 36 patients with rheumatoid arthritis, after mean 6 (2-10) years. Patients were assessed clinically both pre- and postoperatively (pain, instability, motion, ulnar neuropathy) and radiographically. Furthermore, at the time of follow-up clinical outcome was assessed using the Elbow Function Assessment Scale.
At review, 7 of 49 elbows had undergone revision because of symptomatic loosening of the ulnar component. In 42 unrevised elbows, clinical outcome was excellent in 29, good in 7, fair in 5, and poor in one. 31 of 42 elbows had no pain; 11 were painful at rest (VAS 1-2) and/or as a result of activity (VAS 1-8). With revision as endpoint, survival was 86% at 6 years. Intraoperative malpositioning of the ulnar component with a valgus or varus alignment of < 5 degrees was associated with worse survival.
We found an unexpectedly high rate of loosening of the ulnar component, which was associated with intraoperative malpositioning of the prosthesis. The ulnar component of this prosthesis should not be inserted without cement in patients with rheumatoid arthritis.
Kudo 5型肘关节假体的两个组件均可在有或没有骨水泥的情况下植入。目前尚无关于类风湿性关节炎患者使用所有组件均无骨水泥固定的该假体的报道。
我们回顾了36例类风湿性关节炎患者植入的49个初次无骨水泥固定的Kudo 5型肘关节假体，平均随访6（2 - 10）年。对患者进行术前和术后的临床评估（疼痛、不稳定、活动度、尺神经病变）以及影像学评估。此外，在随访时使用肘关节功能评估量表评估临床结果。
复查时，49个肘关节中有7个因尺侧组件出现症状性松动而进行了翻修。在42个未翻修的肘关节中，临床结果优的有29个，良的有7个，可的有5个，差的有1个。42个肘关节中有31个无疼痛；11个在休息时疼痛（视觉模拟评分1 - 2）和/或因活动而疼痛（视觉模拟评分1 - 8）。以翻修为终点，6年生存率为86%。尺侧组件术中出现内翻或外翻角度<5度的位置不当与较差的生存率相关。
我们发现尺侧组件松动率出乎意料地高，这与假体术中位置不当有关。对于类风湿性关节炎患者，该假体的尺侧组件不应无骨水泥植入。
