Abstract
In this study we reviewed all Total Elbow Replacements (TER) done in our hospital over eight years period (1997 – 2005), 21 patients (16 females, 5 males) were available for follow up and four were lost (two died and two moved out of the region) with average age of 65 years (range 44 – 77), all procedures were done by two upper limb surgeons (CHB & RGW). 16 patients (14 females, 2 males) had the procedure for Rheumatoid Arthritis and 5 patients (3 males, 2 females) undergone the procedure for post-traumatic arthritis.
The average follow up was 61 months (range 12 – 120 months), the Mayo Clinic performance index, the DASH scores and activities of daily living (adopted from Secec Elbow Score) assessment tools were used. In addition, all patients were assessed for loosening using standard AP and lateral radiographs. Sixteen patients had Souter-Starthclyde prosthesis whilst three had Kudo and two had Conrad-Moorey prosthesis.
All procedures were done through dorsal approach and all were cemented, the ulnar nerve was not transposed in any of the cases. The average elbow extension lag was 27 degrees (range 15 – 35) with flexion up to 130 degrees (range 110 – 140). Supination was 65 degrees (range 15 – 90) and pronation was 77 (range 55 – 90). The average DASH score was 51.3 (range 19 – 95), the Mayo elbow score was 82 (range 55 – 100) and the average Activities of daily living Secec Score was 17 (range 10 – 20).
There were four complications, three ulnar nerve paresis which recovered and one wound complication which needed a flap cover. Two needed revision surgery, one for a periprosthetic fracture and one for loosening. Two patients showed radiological signs of loosening but were asymptomatic. The survival rate with revision as the end point is 95% for aseptic loosening and 90% for any other reason.
Our study proves TER has good medium term results with good functional outcome and high patient satisfaction rate.
