title: Results of Total Elbow Arthroplasty with Cementless Implantation of an Alumina Ceramic Elbow Prosthesis for Patients with Rheumatoid Arthritis.
abstract: We investigated the long-term clinical results of total elbow arthroplasty (TEA) by cementless fixation of alumina ceramic unlinked elbow prostheses (J-alumina ceramic elbows: JACE) for the reconstruction of elbow joints with rheumatoid arthritis (RA). Seventeen elbows in 17 patients (aged 44-72 years, average 54.8) replaced by JACE TEA without bone cement were investigated. The average follow-up period was 10.7 (range, 1.0-19.3) years. Clinical conditions of each elbow before and after surgery were assessed according to the Mayo Elbow Performance Index (MEPI). Radiographic loosening was defined as a progressive radiolucent line of more than 1 mm that was completely circumferential around the intramedullary stem. The average MEPI significantly improved from 46.8 points preoperatively to 66.8 points at final follow-up (p=0.0226). However, aseptic loosening was noted in 10 of 17 elbows (58.8%) and revision surgery was required in 7 (41.2%). Most loosening was observed on the humeral side. With radiographic loosening and revision surgery defined as the end points, the likelihoods of prosthesis survival were 41.2% and 51.8%, respectively, up to 15 years by Kaplan-Meier analysis. The clinical results of JACE implantation without bone cement were disappointing, with high revision and loosening rates of the humeral component.
authors.affiliation: Department of Human Morphology, Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.knishida@md.okayama-u.ac.jp.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Nishida
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hashizume
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ozawa
authors.forename: Ayumu
authors.initials: A
authors.lastname: Takeshita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaneda
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Nakahara
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nasu
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Shimamura
authors.forename: Hajime
authors.initials: H
authors.lastname: Inoue
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000537:Aluminum Oxide / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D002484:Cementation / Q000379:methods*; D004551:Elbow Joint / Q000601:surgery*; D058569:Elbow Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000537:Aluminum Oxide
keywords: JACE; alumina ceramic; rheumatoid arthritis; total elbow arthroplasty; unlinked elbow