抄録
Objective: Total elbow joint arthroplasty has limited longevity and is therefore not appropriate for younger rheumatoid arthritis (RA) patients. Arthroplasty using an inter-positional membrane may be another surgical option for this population. However, clinical results for joint arthroplasty using an inter-positional membrane have not traditionally been favorable because rheumatoid activity could not be controlled. Today, rheumatoid activity can be controlled with biologics; therefore, the utility of the inter-positional membrane procedure was re-evaluated.
Methods: An 8×6-cm sheet of fascia was detached from the patient's tensor fascia lata muscle to produce a JK membrane. The fascia was stretched on a frame and kept in a 2% chromic acid potassium solution for 24 h. Then, the fascia was exposed to direct sunlight to reduce the dichromic acid. The fascia was washed in running water for 24 h and was then stored in phenol with the addition of 70% alcohol. Elbow arthroplasties were performed on three elbow joints in two young female RA patients (32 and 34 years old). The first patient had a significantly damaged right elbow joint with severe joint dysfunction. A JK-membrane arthroplasty was done in 2003, when the patient was 34 years old. Biologics were administered with methotrexate after the surgery. The second patient demonstrated bilateral ankylosed elbows as a result of idiopathic juvenile arthritis. Bilateral JK membrane arthroplasties were performed in 2010, when the patient was 32 years old. Several operative and manual manipulations were necessary to increase the range of motion following surgery. Biologics were administered with cyclosporine.
Results: Joint function was significantly improved in all three joints without pain after the JK-membrane elbow arthroplasties. In the first patient, the Japan Orthopaedic Association (JOA) elbow score improved from 21 points before surgery to 85 points after surgery, and active elbow flexion improved to 110° following surgery. In the second patient, the JOA elbow score was 55 and 82 points in the right elbow and 52 and 83 points in left elbow before and after surgery, respectively. Active flexion improved to 120° for the right elbow and 110° for the left elbow following surgery. RA was well controlled in both patients.
Conclusion: Elbow arthroplasty using an inter-positional membrane appears to be useful in young patients when RA activity is controlled with biologics.
