Synovectomy of the elbow and radial head excision in rheumatoid arthritis
Date
1997
Authors
Gendi, Nagui S. T.
Axon, Jeremy M. C.
Carr, Andrew J.
Pile, Kevin D.
Burge, Peter D.
Mowat, Alastair G.
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Advisors
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Journal article
Citation
Journal of Bone and Joint Surgery. 79-B(6):918-923
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Nagui S. T. Gendi, Jeremy M. C. Axon, Andrew J. Carr, Kevin D. Pile, Peter D. Burge, Alastair G. Mowat
Conference Name
Abstract
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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© 1997 British Editorial Society of Bone and Joint Surgery