Kudo Total Elbow Arthroplasty in Rheumatoid Arthritis. Clinical and Radiological Results

Abstract

We have analysed the results of 28 total elbow replacements in 27 patients. The replacements were made using the Kudo unconstrained, unlinked, total elbow prosthesis. The elbows were all affected by rheumatoid arthritis. The follow-up time was from 3 to 7 years, with a mean follow-up of 58 months. Our results with this prosthesis in rheumatoid arthritis appear promising and only few complications were noticed. In one case, a radiological loosening of the ulnar component was observed at the 5-year visit but without any clinical symptoms and no operations were needed. In two other cases, an open reduction was performed within the first 3 months to correct a subluxation. A triceps tendon was re-inserted for a fourth patient 55 months postoperatively. In general, the range of motion became statistically significantly better with the prosthesis and there was also a high rate of relief of pain in patients in whom the elbow was severely affected by rheumatoid arthritis.

Instrumented Bone Preserving elbow prosthesis in rheumatoid arthritis: 2-8 year follow-up

“…2 Although dislocation is associated with unlinked prosthesis, it has only been described in 3 studies of the Kudo 5. 4,13,14 In our study, 1 patient had radiological and clinical signs of dislocation. The patient suffered no pain, but due to his co-morbidities and his old age, he refused revision surgery.…”

“…Most studies did not show these complications as well. 2,5,6,[9][10][11][14][15][16][17] Previous studies described that the ulnar component is the one most at risk of loosening. 1,4,9,12,15,16 Furthermore, in the present series, both revision and radiolucencies occurred more often in uncemented ulnar components than in the cemented ones, except in 1 study by Kudo et al in 1999, in which 11 uncemented ulnar components were implanted uncemented without any signs of loosening.…”

Triceps Insufficiency After Total Elbow Arthroplasty

“…A total of 215 cases of triceps insufficiency were reported in 80 articles 1,3,6,8,16-91 . The mean incidence was 4.5% (range, 0% to 54.8%).…”

“…The mean incidence was 4.5% (range, 0% to 54.8%). Detailed information on primary or revision surgery was retrieved from 77 articles 1,3,8,16-36,38-80,82-91 . Missing data on these parameters warranted exclusion from this section.…”

The Clinical Performance of UHMWPE in Elbow Replacements

“…The use of a titanium-on-UHMWPE bearing surface was associated with metallosis and osteolysis in some patients [46]. While the Kudo system has had high survival rates at some institutions, the rate of reported loosening of the humeral and ulnar components has been varied [18,43,[46][47][48][49][50][51][52][53]. The current system consists of cobalt chrome components with a titanium porous coating on the ulnar component and the distal half of the stem (Figure 10.17).…”