Abstract
Background
Previously, the Coonrad-Morrey elbow system has typically been performed using linked-type total elbow arthroplasty (TEA) implants. However, this implant have been reported to be associated with some problems, such as wearing down, loosening, the complexity of the necessary surgical techniques and inappropriate implant size for Asian people.
The Discovery elbow system (Biomet Inc., Warsaw, US) has recently been developed and it has many advantages when compared to Coonrad-Morrey implant, but the treatment outcome for this system is unclear in patients with rheumatoid arthritis (RA).
Objectives
The aim of this study was to clarify the outcome of TEA using the Discovery elbow system.
Methods
Eleven RA patients (13 elbows) who underwent TEA using the Discovery elbow system were investigated in this study. Two patients (3 elbows) were males, and 9 patients (10 elbows) were females. Ten were right elbows, and 3 were left elbows. Two elbows has Larsen grade “disease, 7 had grade” disease and 4 elbows underwent revision surgery.
The surgical approach used for all cases was Campbell's posterior approach. The Discovery elbow system was installed using cemented fixation. Two weeks after the operation, ROM exercise was started. The elbow ROM, Mayo elbow performance score (MEPS), and any complications observed at baseline, 6 months and 24 months after surgery were assessed.
Results
The preoperative elbow ROM (mean±SD) was −33.4±4.4° in extension, 133.5±3.4° in flexion, 48.5±8.4° pronation and 67.7±5.7° in supination. The postoperative elbow ROM (mean±SD) was −18.5±6.2° in extension, 112.7±6.1° in flexion, 70.0±3.4° in pronation and 73.7±1.6° in supination. As a result, a significant improvement was observed in extension, flexion and pronation. The MEPS improved significantly at 6 months and 24 months after surgery. In addition, no implant loosening was found or revision surgery was required at 24 months after surgery.
Conclusions
In this study, the elbow function was observed to significantly improve by TEA using the Discovery elbow system based on the short-time outcome. However, further study is still needed to clarify the long-term outcome of this implant in RA patients.
