Baghdadi Yaser M K, Jacobson Justin A, Duquin Thomas R, Larson Dirk R, Morrey Bernard F, Sanchez-Sotelo Joaquin
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2014 Sep;23(9):1374-80. doi: 10.1016/j.jse.2014.03.012. Epub 2014 Jun 4.
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.
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).
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.
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.
幼年特发性关节炎（JIA）患者的肘关节假体置换可能很复杂，且在技术上具有挑战性。因此，我们试图评估为治疗这些患者而进行的初次半限制连接式全肘关节置换术（TEA）的临床益处和假体使用寿命。
1983年至2005年间，24例患者（20名女性和4名男性）的29个肘关节因JIA进行了置换。平均年龄为37岁（范围24 - 68岁）。由于存在潜在畸形，9个肘关节（31%）的植入物轮廓进行了修改，5个肘关节（17%）植入了定制植入物。平均随访时间为10.5年（范围4.6 - 20.1年）。
在随访期间，8个肘关节接受了再次手术，其中6个（21%）进行了植入物翻修。在最近一次随访时，22个肘关节（76%）主观上总体功能结果令人满意。Mayo肘关节功能评分平均为78分（范围50 - 100分），18个肘关节评为优良结果。与术前活动范围相比，平均屈伸弧度从65°±44°改善至89°±35°（P = 0.01），平均屈曲从113°±23°改善至126°±26°（P = 0.02），平均伸展从48°±25°改善至37°±26°（P = 0.08）。采用Kaplan - Meier生存分析法，TEA在5年和10年时从任何翻修情况的生存率分别为96.4%（95%置信区间，89.8% - 100%）和79.9%（95%置信区间，65.1% - 97.5%）。
JIA患者的初次TEA在技术上具有挑战性，且经常需要植入物修改或定制设计。这些患者可能有较高的并发症和翻修率。然而，大多数患者长期受益于该干预措施。
