The outcome of total elbow arthroplasty in juvenile idiopathic arthritis (juvenile rheumatoid arthritis) patients

Background: Elbow prosthetic replacement in patients with juvenile idiopathic arthritis (JIA) can be complicated and technically challenging. Thus, we sought to evaluate the clinical benefit and the prosthetic longevity of primary semiconstrained linked total elbow arthroplasty (TEA) performed to treat these patients. Methods: Between 1983 and 2005, 29 elbows in 24 patients (20 women and 4 men) had been replaced because of JIA. The mean age was 37 years (range, 24-68 years). Because of underlying deformity, the implant contour was modified for 9 elbows (31%) and a customized implant was inserted in 5 elbows (17%). The mean follow-up duration was 10.5 years (range, 4.6-20.1 years). Results: During the follow-up period, 8 elbows underwent reoperation, including 6 (21%) that underwent implant revision. At most recent follow-up, 22 elbows (76%) subjectively had a satisfactory overall functional result. The mean Mayo Elbow Performance Score was 78 points (range, 50-100 points), with 18 elbows graded as having an excellent or good result. Compared with preoperative range of motion, the mean extension-flexion arc improved from 65 degrees +/- 44 degrees to 89 degrees +/- 35 degrees (P = .01), mean flexion improved from 113 degrees +/- 23 degrees to 126 degrees +/- 26 degrees (P = .02), and mean extension improved from 48 degrees +/- 25 degrees to 37 degrees +/- 26 degrees (P = .08). By use of the Kaplan-Meier survivorship method, the rate of TEA survival from any revision was 96.4% (95% confidence interval, 89.8%-100%) and 79.9% (95% confidence interval, 65.1%-97.5%) at 5 years and 10 years, respectively. Conclusion: Primary TEA for JIA patients is technically challenging and frequently requires implant modification or custom designs. These patients might have high complication and revision rates. However, most benefit from the intervention for a long term. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.