Niitsuma Gaku, Okano Ichiro, Nishikawa Hiroki, Kawasaki Keikichi, Inagaki Katsunori
Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
J Shoulder Elbow Surg. 2024 Mar;33(3):564-572. doi: 10.1016/j.jse.2023.09.029. Epub 2023 Oct 28.
Total elbow arthroplasty (TEA) has been used for various conditions including rheumatoid arthritis (RA). While the Kudo TEA has been associated with favorable short-term outcomes, there is limited information on the longer term outcomes of this device. The aim of this study was to investigate the average 15-year outcome of Kudo type-5 TEA in patients with RA.
For this retrospective cohort study, we reviewed 29 elbows in 28 patients (Larsen grade III, n = 8; IV, n = 19; V, n = 2) with RA who underwent Kudo type-5 TEA between 1999 and 2010. The patients were followed up for a mean of 15 (range: 10-21) years. We investigated the survival with setting revision/removal as the endpoints. The risk factors for revision/loosening were assessed.
There was a significant improvement in elbow flexion after Kudo TEA. Preoperative and postoperative Mayo Elbow Performance Score improved significantly from 60.3 to 94.7. Complications included intraoperative medial humeral epicondyle fracture (n = 2), postoperative dislocations (n = 4), deep infections (n = 1), and persistent ulnar nerve neuropathy (n = 1). Aseptic loosening was observed in 7 elbows (24.1%; humerus, n = 3; ulna, n = 3; both sides, n = 1). The causes of the 5 revisions were postoperative dislocation (n = 1), deep infection (n = 1), aseptic loosening of the humerus (n = 2), and aseptic loosening of the ulna (n = 1). All 5 elbows underwent revision of the ulnar component (n = 2) or the linked TEA (n = 3). The survival rate was 81% at 15 years after surgery with setting revision/removal as the endpoints. A deviation of ulnar component insertion angle of over 5° in any plane was associated with more revision compared to those with accurately placed implants.
The Kudo type-5 elbow showed good results for up to 15 years of follow-up. However, excessive deviation of insertion angle of the ulnar component (over 5°) was associated with more revision. Due to the small sample size, robust statistical analysis of risk factors for postoperative complications or revision could not be performed, and further research is warranted to resolve this limitation.
全肘关节置换术（TEA）已用于包括类风湿关节炎（RA）在内的多种病症。虽然 Kud o TEA 与良好的短期疗效相关，但关于该装置长期疗效的信息有限。本研究的目的是调查 RA 患者中 Kud o 5 型 TEA 的平均 15 年疗效。
在这项回顾性队列研究中，我们回顾了 1999 年至 2010 年间接受 Kud o 5 型 TEA 的 28 例患者（Larsen 分级 III 级，n = 8；IV 级，n = 19；V 级，n = 2）的 29 个肘关节。患者平均随访 15（范围：10 - 21）年。我们以翻修/取出为终点调查生存率。评估翻修/松动的危险因素。
Kud o TEA 后肘关节屈曲有显著改善。术前和术后 Mayo 肘关节功能评分从 60.3 显著提高到 94.7。并发症包括术中肱骨内上髁骨折（n = 2）、术后脱位（n = 4）、深部感染（n = 1）和持续性尺神经神经病变（n = 1）。7 个肘关节（24.1%）观察到无菌性松动（肱骨，n = 3；尺骨，n = 3；双侧，n = 1）。5 次翻修的原因是术后脱位（n = 1）、深部感染（n = 1）、肱骨无菌性松动（n = 2）和尺骨无菌性松动（n = 1）。所有 5 个肘关节均对尺骨部件（n = 2）或连接的 TEA（n = 3）进行了翻修。以翻修/取出为终点，术后 15 年生存率为 81%。与植入物放置准确的患者相比，尺骨部件在任何平面的插入角度偏差超过 5°与更多的翻修相关。
Kud o 5 型肘关节在长达 15 年的随访中显示出良好的效果。然而，尺骨部件插入角度的过度偏差（超过 5°）与更多的翻修相关。由于样本量小，无法对术后并发症或翻修的危险因素进行强有力的统计分析，有必要进一步研究以解决这一局限性。
