Abstract
Aims: To evaluate the short to medium term outcome of the Souter-Strathclyde prosthesis when used as a primary elbow arthroplasty in rheumatoid arthritis.
Introduction: The Souter-Strathclyde prosthesis has been evaluated in several studies. In our hospital the operation is carried out using the same strict precautions as for lower limb arthroplasty. At the onset of surgery the ulnar nerve is handled minimally. This study looked at infection and complication rates, and also at outcome.
Methods: The operations were carried out in laminar flow theatres and scrubbed staff wore exhaust suits. At the start of the procedure the ulnar nerve was decompressed, but not mobilised from its bed, and held loosely with tape while being kept moist.
Cases were identified from theatre and implant records. 61 implants in 53 patients were identified. Complication and revision rates were established from case sheets. Of this group 19 patients had died, leaving 40 implants in 34 patients suitable for review. Case notes were analysed. Patients were contacted by post and were requested to fill out a DASH form. 30 patients (34 implants) responded; 2 declined to be involved leaving 31 implants in 28 patients to analyse, 78% of those available.
Results: From the 61 implants there were 4 complications within the first year; one ulnar nerve palsy – transient, one dislocated prosthesis – open reduction, two wound infections. The infection rate is thus 3.3%. Overall to date 4 implants from 61 required revision, a rate of 6.6% (range 13–92 months, mean 37 months). Reasons – one loose, two periprosthetic fractures and one infection. Mean follow up at clinic was 74 months (range 36–120). Mean DASH score at follow up was 48.7 (range 4.5–81.8)
Conclusion: The lower incidence of ulnar nerve palsy, compared to published studies, may be attributable to the surgical technique. The use of laminar flow theatres and exhaust suits may account for the lower infection rates. The complication rate and revision rate is favourable compared to previous studies.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
