Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register

Eerik T Skyttä, Antti Eskelinen, Pekka Paavolainen, Mikko Ikävalko, Ville Remes, Eerik T Skyttä, Antti Eskelinen, Pekka Paavolainen, Mikko Ikävalko, Ville Remes

Abstract

Background and purpose: Although total elbow arthroplasty (TEA) is a recognized procedure for the treatment of the painful arthritic elbow, the choice of implant is still obscure. We evaluated the survival of different TEA designs and factors associated with survival using data from a nationwide arthroplasty register.

Methods: 1,457 primary TEAs for rheumatoid elbow destruction were performed during 1982 to 2006 in one hospital specialized in the treatment of rheumatoid arthritis (n = 776) and in 19 other hospitals (n = 681). The mean age of the patients was 59 years and 87% of the TEAs were performed in women. We selected different contemporary TEA designs, each used in more than 40 operations including the Souter-Strathclyde (n = 912), i.B.P./Kudo (n = 218), Coonrad-Morrey (n = 164), and NESimplavit/Norway (n = 63) to assess their individual survival rates. Kaplan-Meier analysis and the Cox regression model were used for survival analysis.

Results: The most frequent reason for revision was aseptic loosening (47%). We found no differences in survival rates between different TEA designs. We did, however, find a 1.5-fold (95% CI: 1.1-2.1) elevated risk of revision in unspecialized hospitals as compared to the one hospital specialized in treatment of rheumatoid arthritis. In the Souter-Strathclyde subgroup, there was a reduced risk of revision (RR 0.6, p = 0.001) in TEAs implanted over 1994-2006 as compared to those implanted earlier (1982-1993). The 10-year survivorship for the whole TEA cohort was 83% (95% CI: 81-86), which agrees with earlier reports.

Interpretation: The influence of implant choice on the survival of TEA is minor compared to hip and knee arthroplasties. Inferior survival rates of the TEAs performed in the unspecialized hospitals demonstrates the importance of proper indications, surgical technique, and postoperative follow-up, and endorses the need for centralization of these operations at specialized units.

Figures

Figure 1.
Figure 1.
Cox-adjusted cumulative survival of TEAs for rheumatoid arthritis in one hospital specialized in the treatment of rheumatoid arthritis (n = 776) and in 19 other hospitals (n = 681) in Finland from 1982 through 2006. The endpoint was defined as revision for any reason. Adjustment was made for age, sex, and prosthesis design.
Figure 2.
Figure 2.
Cox-adjusted cumulative survival of different prosthesis designs used in TEA for rheumatoid arthritis in Finland from 1982 through 2006. The endpoint was defined as revision for any reason. Adjustment was made for age and sex.
Figure 3.
Figure 3.
Cox-adjusted cumulative survival of the Souter-Strathclyde total elbow replacements used for rheumatoid arthritis in Finland over 2 different time periods. Adjustment was made for age, sex, and type of hospital.

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