Revue de chirurgie orthopedique et reparatrice de l'appareil moteur · 2003
[GUEPAR I total elbow arthroplasty in rheumatoid arthritis: 19 implants followed an average of 67 months].
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Mansat P, Alqoh F, Mansat M, Rongières M, Bellumore Y, Bonnevialle P
Аннотация
INTRODUCTION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant used since 1985. Only one multicenter study has reported the mid-term results of this implant in rheumatoid arthritis. We presented a monocentric retrospective study evaluating the results of 19 GUEPAR I total elbow arthroplasty in rheumatoid arthritis with a mean follow-up of 67 months.
MATERIALS AND METHODS: Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started.
RESULTS: At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty.
DISCUSSION-CONCLUSION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion.
MATERIALS AND METHODS: Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started.
RESULTS: At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty.
DISCUSSION-CONCLUSION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion.