Abstract
We studied 12 patients (13 elbows) who underwent total elbow replacement (TER) using the Kudo Mk IV or V prosthesis between 1989 and 1997. There were eight females and four males (mean age: 61 years, range: 38–74 years). The diagnosis was Rheumatoid arthritis in 10 patients and osteoarthritis in two patients. In each patient the initial result was classified as either excellent or good. All these patients then reported the recurrence of severe pain at a mean of four years from the time of the primary operation. Radiographic examination demonstrated fracture of the humeral stem in 10 elbows and subluxation of the joint in three elbows. The fractured humeral components were exchanged for long stem components. The three subluxated elbows were found to have undergone delamination and loosening of the ulnar components which were revised. One of these required revision to a linked prosthesis due to bone loss.
In each case metallosis was found involving principally the synovial tissues which were as far as possible excised. Each patient regained a similar range of movement to that following the primary arthroplasty but continues to experience episodes of pain requiring anti-inflammatory medication. This is in contrast to our patients requiring revision procedures for implant loosening or instability who have become pain free.
We conclude that the development of metallosis complicating mechanical implant failure predisposes to persisting symptoms following revision arthroplasty and recommend that this should be undertaken sooner rather than later when mechanical failure is detected.
The abstracts were prepared by Mr Roger Emery. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN
