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SYNOVECTOMY OF THE ELBOW AND RADIAL HEAD EXCISION IN RHEUMATOID ARTHRITIS

PREDICTIVE FACTORS AND LONG-TERM OUTCOME

N. S. T. Gendi, MSc, MRCP, Consultant Rheumatologist1; J. M. C. Axon, MRCP, Consultant Rheumatologist2; A. J. Carr, FRCS, Consultant Orthopaedic Surgeon3; K. D. Pile, FRACP, Director4; P. D. Burge, FRCS, Consultant Orthopaedic Surgeon3; and A. G. Mowat, FRCP, FRCP Ed, Consultant Rheumatologist3

1 Basildon Hospital, Nether Mayne, Basildon, Essex SS16 5NL, UK.
2 Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire AL7 4HQ, UK.
3 The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
4 Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide 5011, Australia.

Correspondence should be sent to Dr N. S. T. Gendi.

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° in supination-pronation and 11° 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.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General