THE KUDO ELBOW PROSTHESIS-REVIEW OF 105 JOINTS FOLLOWED UP PROSPECTIVELY AT 5 YEARS

Abstract

The history of the development of the Kudo elbow replacement was illustrated from the original Type 1 prosthesis in 1971 to the current Type 5 manufactured in cobalt-chrone and high-density polyethylene from 1994. The results of the Kudo Trial were presented. In this prospective trial all patients had rheumatoid arthritis with at least grade 4 or grade 5 changes on the radiographs. The procedure was carried out by the same surgeon in every case using a posterior approach. The patients were reviewed at regular intervals and the results presented are of those patients at their five-year follow-up.

There were 105 joints replaced in 84 patients (61 females) with an average age of 63 years. Five were revisions of previous implants. Relief of pain was very significant in all cases with only 8 patients experiencing “mild” symptons. The total gain in range of movement was 33° with 10° improvement of extension and 23° of flexion.

The complication rate was low with only one patient having pronounced ulnar nerve dysaesthesia although four had a mild persistence of sensory symptoms.

There were six cases of infection. Three of these were superficial with negative cultures. Three had positive cultures, all staphylococcus aureus and one of these was revised, following gentamicin beads, to a custom built prosthesis and remains clinically and radiologically satisfactory nine years later.

One ulnar component became loose at five years and was satisfactorily replaced with a long stemmed pros-thesis. Radiological “lucent lines” are variably seen and their long-term significance is not fully known.

A survival analysis was carried out using the method of Murray et al, which gave a 10-year survival of 86.7%.