Article

A population-based study from the Finnish Arthroplasty Register. Although total elbow arthroplasty (TEA) is a recognized
procedure for the treatment of the painful arthritic elbow, the choice of implant
is still obscure. We evaluated the survival of different TEA designs and factors
associated with survival using data from a nationwide arthroplasty register.
METHODS: 1,457 primary TEAs for rheumatoid elbow destruction were performed
during 1982 to 2006 in one hospital specialized in the treatment of rheumatoid
arthritis (n = 776) and in 19 other hospitals (n = 681). The mean age of the
patients was 59 years and 87% of the TEAs were performed in women. We selected
different contemporary TEA designs, each used in more than 40 operations
including the Souter-Strathclyde (n = 912), i.B.P./Kudo (n = 218), Coonrad-Morrey
(n = 164), and NESimplavit/Norway (n = 63) to assess their individual survival
rates. Kaplan-Meier analysis and the Cox regression model were used for survival
analysis. RESULTS: The most frequent reason for revision was aseptic loosening
(47%). We found no differences in survival rates between different TEA designs.
We did, however, find a 1.5-fold (95% CI: 1.1-2.1) elevated risk of revision in
unspecialized hospitals as compared to the one hospital specialized in treatment
of rheumatoid arthritis. In the Souter-Strathclyde subgroup, there was a reduced
risk of revision (RR 0.6, p = 0.001) in TEAs implanted over 1994-2006 as compared
to those implanted earlier (1982-1993). The 10-year survivorship for the whole
TEA cohort was 83% (95% CI: 81-86), which agrees with earlier reports.
INTERPRETATION: The influence of implant choice on the survival of TEA is minor
compared to hip and knee arthroplasties. Inferior survival rates of the TEAs
performed in the unspecialized hospitals demonstrates the importance of proper
indications, surgical technique, and postoperative follow-up, and endorses the
need for centralization of these operations at specialized units.

Langue : ANGLAIS