Synovectomy of the elbow in rheumatoid arthritis.

Brumfield, Robert H.; Resnick, C T

doi:10.2106/00004623-198567010-00003

Cited by 63 publications

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“…Several reports have shown good results following resection of the radial head and synovectomy. [1][2][3][4][5][6][7][8][9][10][11][12][13] The results of total elbow arthroplasty in these patients have also been good. [14][15][16][17][18][19][20][21] Data are limited on the effect of a previous resection of the radial head and synovectomy on subsequent total elbow arthroplasty.…”

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Total elbow arthroplasty after previous resection of the radial head and synovectomy

Whaley

Morrey

Adams

2005

The Journal of Bone and Joint Surgery. British volume

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We examined the effects of previous resection of the radial head and synovectomy on the outcome of subsequent total elbow arthroplasty in patients with rheumatoid arthritis.Fifteen elbows with a history of resection and synovectomy were compared with a control group of patients who had elbow arthroplasty with an implant of the same design. The mean age in both groups was 63 years. In the study group, resection of the radial head and synovectomy had been undertaken at a mean of 8.9 years before arthroplasty. The mean radiological follow-up for the 13 available patients in the study group was 5.89 years (0.3 to 11.0) and in the control group was 6.6 years (2.2 to 12.6). There were no revisions in either group. The mean Mayo elbow performance score improved from 29 to 96 in the study group, with similar improvement in the control group (28 to 87). The study group had excellent results in 13 elbows and good results in two. The control group had excellent results in seven and good results in six.Our experience indicates that previous resection of the radial head and synovectomy are not associated with an increased rate of revision following subsequent arthroplasty of the elbow. However, there was a higher rate of complication in the study group compared with the control group.The challenge for orthopaedic surgeons treating patients with rheumatoid arthritis of the elbow is to achieve a painless, stable, and functional elbow. The initial management consists of medical treatment to control synovitis. If this fails, various surgical options can be considered. Several reports have shown good results following resection of the radial head and synovectomy. [1][2][3][4][5][6][7][8][9][10][11][12][13] The results of total elbow arthroplasty in these patients have also been good. [14][15][16][17][18][19][20][21] Data are limited on the effect of a previous resection of the radial head and synovectomy on subsequent total elbow arthroplasty. 22 Our aim, therefore, was to compare the outcome of total elbow arthroplasty with and without a history of previous surgery. Patients and MethodsWe used the joint replacement computer database at our institution to identify those patients with rheumatoid arthritis who had been treated by total elbow arthroplasty (Coonrad Morrey; Zimmer, Warsaw, Indiana) and who had a previous excision of the radial head and synovectomy. To detect more accurately the effect, if any, of the previous surgery, a control group was identified. This was developed from a database of patients with rheumatoid arthritis who had been treated using the same prosthesis during the same period of time. None had a previous resection of the radial head and synovectomy and they were matched by gender, side of involvement, and age. There was a minimum follow-up of two years for both groups. We retrospectively reviewed the records and radiographs of both groups. Additional contact was attempted in all patients. The Mayo elbow performance score (MEPS) was used to assess pain, movement, stability, and daily function as has been ...

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Total elbow arthroplasty after previous resection of the radial head and synovectomy

Whaley

Morrey

Adams

2005

The Journal of Bone and Joint Surgery. British volume

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“…However, several studies have reported that little improvement of elbow motion could be expected in advanced stages, and some elbows developed ankyloses (Inglis et al 1971, Marmor 1972, Wilson et al 1973, Porter et al 1974, Brumfield & Resnick 1985. The main purpose of our operative procedure was to increase the range of motion, as well as to give relief of pain.…”

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confidence: 99%

“…However, the functional outcome does not always correlate with relief of pain (Inglis et al 1971, Brumfield et al 1985.…”

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Radical synovectomy with muscle release for the rheumatoid elbow

Saito

Koshino

Okamoto

et al. 1986

Acta Orthopaedica Scandinavica

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“…7,8,[14][15][16][17][18] Most report that 90% of the patients achieve relief of pain for up to three years. The results, however, deteriorate with time with an overall success rate of 75% to 80% at five years 19 and of 67% at ten years.…”

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confidence: 99%

Arthroscopic Synovectomy of the Elbow for Rheumatoid Arthritis

Lee

Morrey

1997

The Journal of Bone and Joint Surgery. British volume

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The short-term assessment of 14 arthroscopic synovectomies of the elbow in 11 patients with rheumatoid arthritis showed that 93% achieved a short-term rating of excellent or good on the Mayo Elbow Performance Score. At the most recent assessment at an average of 42 months, however, only 57% maintained excellent or good results; four had required total elbow replacement.Although rehabilitation is facilitated by an arthroscopic procedure the results deteriorate more rapidly than after open synovectomy. This may be due to the limitations of the arthroscopic technique and is consistent with experience of the similar procedure in the knee. Recognition of the short-term gain and the potential for serious nerve injury should be considered when offering arthroscopic synovectomy.

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Synovectomy of the elbow in rheumatoid arthritis.

Cited by 63 publications

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Total elbow arthroplasty after previous resection of the radial head and synovectomy

Total elbow arthroplasty after previous resection of the radial head and synovectomy

Radical synovectomy with muscle release for the rheumatoid elbow

Arthroscopic Synovectomy of the Elbow for Rheumatoid Arthritis

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