title: Synovectomy of the elbow and radial head excision in rheumatoid arthritis. Predictive factors and long-term outcome.
abstract: We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were revision surgery (performed or desired) and/or the presence of significant or severe pain. The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per year. The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compared. A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04). At review, there was a mean gain of 50 degrees in supination-pronation and 11 degrees in flexion-extension; both correlated with success. Failure correlated with recurrence of synovitis, elbow instability, ulnar neuropathy, poor general mobility and poor upper-limb function. The last was independently affected by the severity of RA in the ipsilateral shoulder. Our findings show that although the short-term result of ES and RHE in rheumatoid arthritis is good, the long-term outcome is poor except in a subgroup with more than 50% limitation of forearm rotation.
authors.affiliation: Nuffield Orthopaedic Centre, Oxford, England, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Gendi
authors.forename: J M
authors.initials: JM
authors.lastname: Axon
authors.forename: A J
authors.initials: AJ
authors.lastname: Carr
authors.forename: K D
authors.initials: KD
authors.lastname: Pile
authors.forename: P D
authors.initials: PD
authors.lastname: Burge
authors.forename: A G
authors.initials: AG
authors.lastname: Mowat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D010149:Postoperative Pain / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D011403:Pronation / Q000502:physiology; D011884:Radius / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology; D013484:Supination / Q000502:physiology; D016019:Survival Analysis; D000074402:Synovectomy; D013585:Synovitis / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000503:physiopathology