Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Joetsu, Japan.
J Shoulder Elbow Surg. 2019 May;28(5):915-924. doi: 10.1016/j.jse.2018.10.030. Epub 2019 Jan 8.
Total elbow arthroplasty (TEA) is a treatment option for destructive and painful unstable elbows in rheumatoid arthritis (RA). We evaluated the clinical outcomes of unconstrained TEA (Niigata-Senami-Kyocera modular system).
Seventy-five unconstrained TEAs were performed in patients with RA (mean age, 64 years; age range, 41-79 years; follow-up rate, 97%). Outcome measures included the Japanese Orthopaedic Association (JOA) functional evaluation score for the elbow joint (JOA score), range of motion, and arc. Bone ingrowth of the humeral component, the incidence of stress shielding around the humeral component, the incidence of loosening of the ulnar component, complications, and the survival rate were investigated.
The mean follow-up period was 5.2 years (range, 2-11.3 years). The JOA elbow score improved from 42 points preoperatively to 87 points postoperatively (P < .0001). Each specified item improved (P < .0001). Flexion improved from 109° to 134°; the flexion-plus-extension arc improved from 70° to 108° (P < .0001). Bone ingrowth of the humeral implant was achieved in all elbows. Stress shielding of the humeral component was detected in 11 elbows (14%); it was significantly higher in 10- and 9-mm-diameter humeral stems than in 8-mm-diameter humeral stems (P = .008). The ulnar component showed no loosening except in 1 elbow owing to infection. Complications were detected in 9 patients (9 elbows, 12%): periprosthetic infection (3), fracture (4), and dislocation (2). The survival rates were 97% at 5 years and 93% at 10 years postoperatively.
The Niigata-Senami-Kyocera modular system for patients with RA showed good outcomes. Stress shielding can be avoided by using an 8-mm-diameter humeral stem.
全肘关节置换术（TEA）是类风湿关节炎（RA）破坏性和疼痛性不稳定肘关节的一种治疗选择。我们评估了非约束性 TEA（新潟-船桥-京瓷模块系统）的临床结果。
对 75 例 RA 患者进行了非约束性 TEA（平均年龄 64 岁；年龄范围 41-79 岁；随访率 97%）。评估结果包括日本矫形协会（JOA）肘关节功能评估评分（JOA 评分）、活动范围和弧。评估了肱骨组件的骨长入、肱骨组件周围应力遮挡的发生率、尺骨组件松动的发生率、并发症和生存率。
平均随访时间为 5.2 年（范围 2-11.3 年）。JOA 肘部评分从术前的 42 分提高到术后的 87 分（P<.0001）。每个特定项目均有所改善（P<.0001）。屈曲从 109°改善到 134°；屈伸弧从 70°改善到 108°（P<.0001）。所有肘部均实现了肱骨植入物的骨长入。肱骨组件发生应力遮挡 11 例（14%），10mm 和 9mm 直径肱骨柄明显高于 8mm 直径肱骨柄（P=.008）。除 1 例因感染导致的尺骨组件松动外，无其他松动。9 例患者（9 例肘部，12%）出现并发症：假体周围感染（3 例）、骨折（4 例）和脱位（2 例）。术后 5 年和 10 年的生存率分别为 97%和 93%。
RA 患者的新潟-船桥-京瓷模块系统显示出良好的结果。使用 8mm 直径的肱骨柄可以避免应力遮挡。
