Anatomical interposition arthroplasty with dermal graft. A study of 51 elbow arthroplasties on 48 rheumatoid patients.

Seventy anatomical interposition arthroplasties of the elbow joint without ulnar nerve transposition were performed on 67 rheumatoid patients by one surgeon during the years 1978-1984. Between 1 and 6 years after arthroplasty, 51 arthroplasties were re-examined, the average follow-up being 3 years. There were 48 patients, 44 female (aged 25 to 66 years, mean 51) and four male, (aged 59 to 69 years, mean 63). The duration of the rheumatoid disease (46 cases of rheumatoid arthritis, 2 of juvenile chronic arthritis) was 4 to 33 years, mean 17 years. The disease was clinically active in 47 cases. ESR ranged from 12 to 82, mean 50. 51 elbow joints, 32 right (31 dominant), 19 left (2 dominant), had been affected for six months to 29 years, mean 8 years. 21 joints had been operated on one to four times before arthroplasty. Preoperative radiological joint destruction was of Larsen grade IV in 45 cases and of grade V in six cases. Flexion contracture was diminished from preoperative 0 degrees to 70 degrees, mean 38 degrees, to postoperative 0 degrees to 70 degrees, mean 25 degrees. Range of flexion was improved from preoperative 20 degrees to 150 degrees, mean 90 degrees, to postoperative 40 degrees to 145 degrees, mean 109 degrees. Before arthroplasty there were ulnar nerve symptoms in 13 cases, two of which had temporary ulnar symptoms postoperatively, too. After arthroplasty, eight patients had ulnar nerve symptoms, five of which had had previous operations of the joint.