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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2003 August;54(4):305-20
Elbow prosthesis in rheumatoid arthritis. Personal experience
Gualtieri G. V.
Centro per la Chirurgia in Artrite Reumatoide Casa di Cura S. Siro, Milano
Aim. The aim of this study is to evaluate the results of elbow prosthesis in rheumatoid patients.
Methods. Personal experience in 30 cases of elbow prosthesis especially in rheumatoid patients (28 cases), starting from June 1986 until December 2001, is presented. The experience is divided into 2 parts: the first regarding the Souter-Strathclyde prostheses (May 1988-January 1998), the second the GSB III prostheses performed from February 1998 to C) De-cember 2001. A short initial experience (June 1986-October 1987) with the GSB II (3 cases) is not evaluated in this study because of patients missing at this control.
Results. If a comparison is made, the good results with the Souter-Strathclyde prostheses are nearly 70%, while the good and excellent results with the GSB III are more than 91% of the cases. However, we have to consider that our experience with the Souter’s prostheses began 10 years before using the GSB III. During this period we have had the opportunity to correct our initial mistakes and improve the surgical technique.
Conclusions. In our experience, rheumatoid arthritis represents the most important indication for the elbow prosthesis. Sometimes, in post-traumatic arthritis or malunion or pseudoarthrosis, the elbow prosthesis is indicated. Decisive factors for the survival of an implantation are the continuous improvement of the surgical technique and the biomechanical development of the prostheses, as the GSB III less- constrained. The loose-link connection between humerus and ulna allows an angle of 3°-5° for axial deviations and rotation. Through this freedom of motion, the anchoring of the humeral and ulna components is much less strained and avoids the peaks of force on the ends of the anchoring shafts.