Linked semiconstrained and unlinked total elbow replacement in juvenile idiopathic arthritis: a case comparison series with mean 11.7-year follow-up.
BACKGROUND
Few series report the results of total elbow replacement (TER) in patients with juvenile idiopathic arthritis (JIA). Most report the use of a linked implant. There are theoretical benefits to using an unlinked prosthesis, and thus we report our experience of the clinical benefit and survivorship of both this implant and a linked semiconstrained prosthesis.


METHODS
There were 21 elbows replaced in 14 JIA patients (12 women and 2 men; 14 unlinked, 7 linked). Mean age at surgery was 39.5 years (range, 26-52 years). Mean clinical follow-up was 11.7 years (range, 5.4-17.6 years).


RESULTS
Reoperation, including implant revision, was required in 9 elbows (42.9%). Using revision as an end point, survivorship was 95% (95% confidence interval [CI], 74%-99%) at 5 years and 68% (95% CI, 45%-86%) at 10 years. The 10-year survival was 70% (95% CI, 40%-89%) for the unlinked group and 69% (95% CI, 28%-94%) for the linked group. The need for bilateral TER was found to be a risk factor for revision within 10 years of primary surgery (6/11 vs. 0/7 elbows; P = .037). The rate of aseptic loosening seen on radiographs was high in the unlinked group (12/14, 85.7%), but many of these patients continue to function well without need for revision.


CONCLUSIONS
Both the unlinked Kudo 5 and linked Coonrad-Morrey prostheses for TER can provide benefits in the long-term for most patients with JIA. The need for bilateral TER in this group is associated with higher rate of revision at 10 years.
Wexham Park and Heatherwood Hospitals, Frimley Health NHS Trust, Slough, Berkshire, UK. Electronic address: edward.ibrahim@uclmail.net.
Edward F
EF
Ibrahim
Wexham Park and Heatherwood Hospitals, Frimley Health NHS Trust, Slough, Berkshire, UK.
Abbas
A
Rashid
Wexham Park and Heatherwood Hospitals, Frimley Health NHS Trust, Slough, Berkshire, UK.
Michael
M
Thomas
D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors; D016896:Treatment Outcome
Total elbow replacement; elbow arthroplasty; juvenile arthritis; linked; semiconstrained; unlinked