Patrik Hänninen1, Tuukka Niinimäki2, Tapio Flinkkilä2, Jaakko Niinimäki3, Pasi Ohtonen2, Susanna Yli-Luukko2, Juhana Leppilahti2. 1. Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center, Oulu, Oulu University Hospital, University of Oulu, PL 21, 90029 OYS, Oulu, Finland. patrik.hanninen@lshp.fi. 2. Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center, Oulu, Oulu University Hospital, University of Oulu, PL 21, 90029 OYS, Oulu, Finland. 3. Research Unit of Medical Imaging, Physics and Technology, Medical Research Center, Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
Abstract
BACKGROUND: Discovery Elbow System (DES) is a semi-constrained prosthesis, mainly used for patients with rheumatoid arthritis (RA). METHODS: Records from 79 patients with RA (90 DES arthroplasties) were reviewed; 47 patients with 55 DES elbows were re-examined. Range of motion (ROM) of both elbows, upper limb function, and quality of life (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Elbow Performance Score [MEPS], and the RAND 36-Item Health Survey [RAND-36]) were assessed. Cementing quality was assessed, and radiolucent lines measured from plain radiographs. Mean follow-up was 64 (range 24-123) months. RESULTS: Pre-operatively to post-operatively, mean elbow flexion improved from 120° to 146° (p < 0.001) and mean extension lag improved from 29° to 24° (p = 0.02), respectively. At follow-up, mean supination was 66°, mean pronation was 69°, and mean grip strength was 14 kg. Grip strength and ROM (except supination) were similar between the DES elbow and contralateral un-operated elbow. Mean post-operative MEPS was 93 points (excellent, n = 38; good, n = 14; fair, n = 2; and poor, n = 1). Mean DASH score was 43 points. The RAND-36 showed that physical functioning, physical role functioning, bodily pain, and general health were lower than the Finnish reference values. Primary cementing was challenging, and radiolucent lines appeared during follow-up. Four prostheses were revised because of aseptic loosening (n = 3) and periprosthetic fracture (n = 1). CONCLUSION: DES provides significant improvement in patient's flexion-extension arc. Cementing of the elbow prosthesis was challenging; radiolucent lines appeared during the 5-year follow-up, but their clinical relevance remains unclear. First-generation locking screws may loosen over time. LEVEL OF EVIDENCE: Level IV.
BACKGROUND: Discovery Elbow System (DES) is a semi-constrained prosthesis, mainly used for patients with rheumatoid arthritis (RA). METHODS: Records from 79 patients with RA (90 DES arthroplasties) were reviewed; 47 patients with 55 DES elbows were re-examined. Range of motion (ROM) of both elbows, upper limb function, and quality of life (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Mayo Elbow Performance Score [MEPS], and the RAND 36-Item Health Survey [RAND-36]) were assessed. Cementing quality was assessed, and radiolucent lines measured from plain radiographs. Mean follow-up was 64 (range 24-123) months. RESULTS: Pre-operatively to post-operatively, mean elbow flexion improved from 120° to 146° (p < 0.001) and mean extension lag improved from 29° to 24° (p = 0.02), respectively. At follow-up, mean supination was 66°, mean pronation was 69°, and mean grip strength was 14 kg. Grip strength and ROM (except supination) were similar between the DES elbow and contralateral un-operated elbow. Mean post-operative MEPS was 93 points (excellent, n = 38; good, n = 14; fair, n = 2; and poor, n = 1). Mean DASH score was 43 points. The RAND-36 showed that physical functioning, physical role functioning, bodily pain, and general health were lower than the Finnish reference values. Primary cementing was challenging, and radiolucent lines appeared during follow-up. Four prostheses were revised because of aseptic loosening (n = 3) and periprosthetic fracture (n = 1). CONCLUSION:DES provides significant improvement in patient's flexion-extension arc. Cementing of the elbow prosthesis was challenging; radiolucent lines appeared during the 5-year follow-up, but their clinical relevance remains unclear. First-generation locking screws may loosen over time. LEVEL OF EVIDENCE: Level IV.
Authors: Sebastian Mukka; Gustaf Berg; Hamid R Haj Hassany; Alan K Koye; Göran Sjödén; Arkan S Sayed-Noor Journal: Arch Orthop Trauma Surg Date: 2015-03-04 Impact factor: 3.067
Authors: Michael D McKee; Christian J H Veillette; Jeremy A Hall; Emil H Schemitsch; Lisa M Wild; Robert McCormack; Bertrand Perey; Thomas Goetz; Mauri Zomar; Karyn Moon; Scott Mandel; Shirlet Petit; Pierre Guy; Irene Leung Journal: J Shoulder Elbow Surg Date: 2008-09-26 Impact factor: 3.019
Authors: Mark A Frankle; Dolfi Herscovici; Thomas G DiPasquale; Matthew B Vasey; Roy W Sanders Journal: J Orthop Trauma Date: 2003-08 Impact factor: 2.512
Authors: Esa Jämsen; Lauri J Virta; Markku Hakala; Markku J Kauppi; Antti Malmivaara; Matti U K Lehto Journal: Acta Orthop Date: 2013-06-25 Impact factor: 3.717
Authors: Vasileios Samdanis; Gopikanthan Manoharan; Robert W Jordan; Adam C Watts; Paul Jenkins; Rohit Kulkarni; Michael Thomas; Amar Rangan; Stuart M Hay Journal: Shoulder Elbow Date: 2019-09-12