Department of Orthopaedic Surgery & Rehabilitation Medicine, University of Chicago, Chicago, IL, USA.
St Joseph's Hospital, Roth | McFarlane Hand & Upper Limb Center, London, ON, Canada.
J Shoulder Elbow Surg. 2019 Nov;28(11):2205-2214. doi: 10.1016/j.jse.2019.07.029.
Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA.
All patients with RA who underwent TEA at a single center with a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up.
We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components.
TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed.
全肘关节置换术（TEA）常用于类风湿关节炎（RA）患者。本研究的目的是比较使用可转换系统的非连接型和连接型 TEA 在 RA 患者中的结果和并发症。
回顾在一家单中心接受 TEA 治疗且随访时间至少 2 年的所有 RA 患者。在最近的随访时评估患者的人口统计学信息、患者报告的结果评分、功能结果评估和影像学参数。
我们评估了 82 例 RA 患者（27 例采用非连接型 TEA，55 例采用连接型 TEA）。手术时的平均年龄为 61±10 岁，平均随访时间为 6±4 年。两组患者的人口统计学特征相似，除非连接组的随访时间更长（8 年比 5 年，P=0.001）外。两组患者的活动范围无差异。除旋前力量外（非连接型为 74%±8%，连接型为 100%±8%，P=0.03），两组的肘力量相似。平均 Mayo 肘关节功能评分 83±16；患者自评肘关节评分 15±18；简易上肢功能测试（DASH）评分 34±20。非连接型和连接型装置的再手术率（17%比 24%，P=0.4）、并发症发生率（32%比 31%，P=0.4）或翻修率（13%比 17%，P=0.3）无差异。4 例因不稳定而接受翻修的患者均采用非连接型设计，所有 4 例因光滑短柄尺骨组件无菌性松动而接受翻修的患者均采用连接型设计。
在 RA 患者中，使用可转换植入物设计的 TEA 在中期随访时可提供良好的患者报告结果。我们的研究未能检测到使用非连接型或连接型植入物设计的差异；需要进一步进行大型比较试验。
