Limited extension after linked total elbow arthroplasty in patients with rheumatoid arthritis

Abstract

Objective: Total elbow arthroplasty (TEA) has become an established procedure to relieve pain and to increase the range of motion of the destructed elbow in patients with rheumatoid arthritis (RA). However, some patients still have limited extension after TEA, and the causes of limited extension after TEA have yet to be elucidated.

Methods: To examine whether widening of the joint space can cause such limited extension, we retrospectively analyzed 55 cases of linked TEA in patients with RA. There were seven male and 40 female with a mean age of 63.8 years (range, 30–80 years) and a mean follow-up of 7.5 ± 4.2 years (range, 2.5–15.6 years). The Mayo Elbow Performance Score (MEPS) and radiological measurements were recorded. Widening of the joint space was calculated by subtracting the length measured on postoperative radiograph from preoperative radiograph.

Results: MEPS and range of motion were significantly improved after surgery except for extension. The degree of extension was significantly correlated with radiological widening of the joint space in the limited extension group. Correlation analyses showed that postoperative limited extension was correlated with lower MEPS daily function.

Conclusions: Limited extension after linked TEA is partly derived from perioperative widening of the joint space and potentially limits daily function in patients with RA.

Keywords:

• Daily function
• Extension loss
• Postoperative outcome
• Rheumatoid arthritis
• Total elbow arthroplasty

Acknowledgments

The authors thank Drs. T. Nakamura, R. Kakinoki, M. Azukizawa, Y. Hamamoto, and H. Tsukiyama for their valuable help and significant contributions to this article.

Ethical Approval

Ethical approval for this study was granted by the committee of Kyoto University Graduate School and Faculty of Medicine (E1785).

Conflict of interest

Moritoshi Furu and Masahiro Ishikawa are affiliated with a department that is supported financially by four pharmaceutical companies (Mitsubishi-Tanabe, Bristol-Myers, Chugai, Eisai). Hiroyuki Yoshitomi is affiliated with a department that is supported financially by Astellas. Hiromu Ito has received grant and research support from Mitsubishi-Tanabe, Chugai, Pfizer, Astellas, and Daiichi Sankyo. Hiroko Ogino and Shuichi Matsuda declared no conflict of interest exists; The sponsors were not involved in the study design, in the collection, analysis, interpretation of data, in the writing of this manuscript, or in the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Supplementary material available online

Supplementary Tables 1–4