Total elbow arthroplasty (TEA) is going to be widely indicated for not only rheumatoid elbow but also unstable elbow, comminuted fracture of distal end of humerus and ankylotic elbow. We reported the case of a patient with rheumatoid elbow with post-traumatic varus deformity who had undergone TEA.
A sixty-year old man who works as a lunch provider admitted our hospital for deformity and instability of the elbow.He had received DMARD and predonisorone for RA, which failed to control his disease activity. Thus he was started on anti-TNF alfa therapy, which reduced poly-arthralgia, however his symptoms in the elbow did not improve. Physical examination showed limitation of range of motion (ROM) and painful instability at his elbow. Radiographic examination revealed thirty degrees of varus deformity and dysplastic change of humeral trochlea. Semi-constrained TEA was selected for his unstable RA elbow, because of massive bone defect of the trochlea and loss of ligamentous structure. Two days after the operation, ROM exercise was started using CPM with flexion blocking over 90 degrees.Postoperatively, ROM (extension/flexion) improved from -30/90; preoperative to -30/120; post-operative,and pain and instability disappeared.The JOA score improved from 39 points preoperatively to 91 points postoperatively, and he returned to former job.
It was thought that TEA was a good procedure for unstable rheumatoid elbow due to severe bone defects or lack of ligamentous stability. Careful follow-up examinations are necessary to prevent implant failures including breakage, aseptic loosening and penetration of humeral or ulnar cortex.
