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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.

Original publication

DOI

10.1302/0301-620x.79b6.7408

Type

Journal article

Journal

The Journal of bone and joint surgery. British volume

Publication Date

11/1997

Volume

79

Pages

918 - 923

Addresses

Nuffield Orthopaedic Centre, Oxford, England, UK.

Keywords

Arm, Radius, Elbow Joint, Synovial Membrane, Shoulder Joint, Ulnar Nerve, Humans, Arthritis, Rheumatoid, Joint Instability, Synovitis, Peripheral Nervous System Diseases, Recurrence, Pain, Postoperative, Range of Motion, Articular, Treatment Outcome, Treatment Failure, Osteotomy, Reoperation, Survival Analysis, Retrospective Studies, Longitudinal Studies, Follow-Up Studies, Pronation, Supination, Forecasting, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male