Total Elbow Arthroplasty with Use of a Nonconstrained Humeral Component Inserted without Cement in Patients Who Have Rheumatoid Arthritis*

Kudo, Hiroshi; Iwano, Kunio; Nishino, Junki

doi:10.2106/00004623-199909000-00008

Cited by 91 publications

(68 citation statements)

References 16 publications

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“…We achieved good pain relief and gain of function in the unrevised elbows, which is in accordance with previous reports on Kudo total elbow arthroplasty (Verstreken et al 1998, Kudo et al 1999, Rahme 2002, Potter et al 2003. Radiographically, there was no migration or fracture of the humeral component of the implant-suggesting that previous problems with the stem of the humeral component of the type 4 Kudo such as metallosis, osteolysis, and ultimately breakage, appear to have been resolved with the Kudo type 5 prosthesis (Kudo et al 1994(Kudo et al , 1999.…”

Section: Discussionsupporting

confidence: 92%

“…Radiographically, there was no migration or fracture of the humeral component of the implant-suggesting that previous problems with the stem of the humeral component of the type 4 Kudo such as metallosis, osteolysis, and ultimately breakage, appear to have been resolved with the Kudo type 5 prosthesis (Kudo et al 1994(Kudo et al , 1999. Similar findings concerning ulnar radiolucency have been reported by others.…”

Section: Discussionsupporting

confidence: 82%

“…Unlinked implants have been associated with dislocation, ulnar neuropathy, infection and wound problems, however (Ferlic 1999). The Kudo type 5 elbow prosthesis is an unlinked minimally-constrained surface replacement that can be inserted with or without the use of cement (Kudo et al 1999). We have found no reports on the use of the Kudo type 5 elbow prosthesis in which all ulnar and humeral components were inserted without the use of cement in patients with RA.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings concerning ulnar radiolucency have been reported by others. It should be noted that only Kudo et al (1999) used an uncemented ulnar component in some but not all of their patients. Potter et al (2003) reported 2 cases of progressive radiolucency-but no revisions-in 29 cemented Kudo type 5 elbow prostheses, with a mean follow-up of 6 years.…”

Section: Discussionmentioning

confidence: 99%

“…It is an unlinked, minimally-constrained prosthesis and its design has undergone several revisions: types 1 and 2 were cemented unstemmed surface replacements; in type 3 a stem was added to the humeral component, and type 4 permitted the insertion of both components without the use of cement (Kudo et al 1980, 1994, 1999, Kudo and Iwano 1990. The current Kudo type 5 elbow prosthesis consists of a humeral component of cobalt-chromium alloy; it is one-half porous-coated with titanium alloy and has an ulnar component that is either all-polyethylene for use with cement or metal-backed with titanium stem with or without a porous coat, for use without cement (Kudo et al 1999). The standard ulnar component has a short stem; a long-stemmed ulnar component has been designed for revision surgery.…”

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confidence: 99%

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Failure mechanisms in uncemented Kudo type 5 elbow prosthesis in patients with rheumatoid arthritis: 7 of 49 ulnar components revised because of loosening after 2–10 years

2007

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Background Both components of the Kudo type 5 elbow prosthesis can be inserted with or without the use of cement. There have been no reports on the use of this prosthesis with all components uncemented in patients with rheumatoid arthritis.Patients and methods We reviewed 49 primary uncemented Kudo type 5 elbow prostheses, inserted in 36 patients with rheumatoid arthritis, after mean 6 (2-10) years. Patients were assessed clinically both pre-and postoperatively (pain, instability, motion, ulnar neuropathy) and radiographically. Furthermore, at the time of follow-up clinical outcome was assessed using the Elbow Function Assessment Scale.Results At review, 7 of 49 elbows had undergone revision because of symptomatic loosening of the ulnar component. In 42 unrevised elbows, clinical outcome was excellent in 29, good in 7, fair in 5, and poor in one. 31 of 42 elbows had no pain; 11 were painful at rest (VAS 1-2) and/or as a result of activity (VAS 1-8). With revision as endpoint, survival was 86% at 6 years. Intraoperative malpositioning of the ulnar component with a valgus or varus alignment of > 5° was associated with worse survival.Interpretation We found an unexpectedly high rate of loosening of the ulnar component, which was associated with intraoperative malpositioning of the prosthesis. The ulnar component of this prosthesis should not be inserted without cement in patients with rheumatoid arthritis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Failure mechanisms in uncemented Kudo type 5 elbow prosthesis in patients with rheumatoid arthritis: 7 of 49 ulnar components revised because of loosening after 2–10 years

2007

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Endoprothesen

Rüther¹,

Fink²

2005

Rheumaorthopädie

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Endoprothesen W. Rçther, B. Fink Abb. 1. Detail der humeralen Komponente bei der Coonrad-Morrey-Prothese: ventraler, hakenartiger Anbau, der mit einem Knochentransplantat zusåtzlich gesichert werden kann, zur Verhinderung der Dorsalwanderung der Prothese. Kopplung der Prothesenteile mittels Steckachse. Endoprothesen ] 281 Abb. 2. Humerale Komponente bei der GSB-III-Prothese: laterale Prothesenflçgel, die ventral erhaeht sind, zur Abstçtzung auf dem humeralen Knochen. Humerale und ulnare Komponente sind çber einen Steckstift miteinander verbunden. Abb. 3. Konzept des ¹sloppy hingeª: die humerale und ulnare Prothesenkomponente weisen eine konstruktive Verbindung auf, die eine Wackelbewegung in Varus-valgus-Richtung und in Rotationsrichtung zulassen. (Aus: Morrey 1993 [39]).

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