Total elbow arthroplasty is associated with a higher occurrence of complications than is usual for large-joint replacements. Two kinds of prostheses, unconstrained and semi-constrained, are currently used and each has its supporters or opponents. In this study the results of the two techniques used in our patients are evaluated and compared. MATERIAL: Two groups of elbows in patients with rheumatoid arthritis were evaluated. One comprised 58 elbows treated by Souter-Strathclyde total elbow arthroplasty (S-S group). The mean age of the patients at the time of surgery was 53 years (range, 22 to 71) and the mean follow-up was 9.5 years (range, 0.7 to 16.7). The other group included 63 elbows treated by Coonrad-Morrey elbow arthroplasty (C-M group). The mean age of the patients at the time of surgery was 54 years (range, 26 to 75) and the mean follow-up was 4.21 years (range, 0.28 to 7.87). METHODS: The Kaplan-Meier analysis was used to estimate implant survival in each group. Clinical assessment included range of motion and pain experience. The Mayo Elbow Performance Score (MEPS) was used as a clinical rating scale for the whole group. Radiographs were taken in two basic projections. The elbows with an implant removed or re-implanted were excluded from the evaluation. The patients were studied prospectively. The results were statistically analysed, with the level of significance set at 0.05. RESULTS: All patients experienced pain relief after surgery. In the S-S group, 35 elbows were free from pain (77.7 %), in the C-M group this was 53 elbows (88.3 %). The range of motion improved after arthroplasty in both groups. Flexion more than 110° was achieved in twice as many elbows in the C-M group than in the S-S group. Flexion contracture in the S-S group did not improve significantly. MEPS values after surgery improved in both groups, with significantly better results in the C-M group. In the S-S group, four elbow arthroplasties (6.9 %) showed instability, which was treated by replacement with a semi-constrained implant in one case and managed by articulated external fixation of the elbow for 6 weeks in three cases. Radiolucent lines were detected in five replacements (11.1 %) along the whole ulnar component width, in 12 (26.6 %) in the olecranon region and in 14 (31.1 %) in the distal humeral component. In the C-M group no radiolucency was recorded around the component. In the S-S group, revision surgery was carried out in 13 arthroplasties (22.4 %); of these, 10 (17.2%) were due to aseptic loosening, one (1.7 %) due to instability and one (1.7%) because of deep infection. In the C-M group, three elbows required revision (4.8 %), one for periprosthetic fracture (1.6 %) and two for deep infection (3.2 %). The results of survival analysis did not differ between the two groups. DISCUSSION: The weak point of Souter-Strathclyde total elbow arthroplasty is the ulnar component whose impairment and subsequent wear are involved in all cases of aseptic loosening. An insufficient length of the humeral component is another risk factor. Even natural movements of the elbow joint produce concentration of stresses on a small surface; this gradually weakens component fixation in bone and results in aseptic loosening. A higher risk of failure in Coonrad-Morrey elbow arthroplasty is associated with polyethylene lining of the hinge mechanism. CONCLUSIONS: The Coonrad-Morrey total elbow replacement is at present considered the method of choice. It is easier to perform and provides better functional outcomes than the Souter-Strathclyde elbow implant.

• MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• protézy a implantáty MeSH
• protézy lokte MeSH
• revmatoidní artritida MeSH
• statistika jako téma MeSH
• totální endoprotéza loketního kloubu metody   využití   MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY On the basis of anatomical dissection of the medial femoral circumflex artery (MFCA) in 32 lower extrmities and our clinical experience with managing the deep MFCA branch during total hip replacement surgery performed from the ante-rolateral approach, we sought a reliable treatment of the injured artery, including identification of the site for making the ligature or the way of avoiding damage to the artery during release of the capsule and pelvitrochanteric muscles. MATERIAL Anatomical dissection in the MFCA region on both lower extremities was carried out in 16 adult human cadavers. None of the bodies showed any signs of pathological lesions or post-operative, hip joint-related conditions. METHODS In 12 limbs, a gelatin injection was applied directly into the MFCA. In the remaining limbs dissection was performed without injecting the vessel. We studied the MFCA topography in relation to the surrounding structures, particularly where the MFCA runs along the femoral neck before entering the capsule. During dissection, we dislocated the hip in order to create a model situation similar to that during total hip replacement and to find out any possible changes in the course and tension of the artery due to manipulation with the limb during surgery. RESULTS Our observations confirmed that if the MFCA is injured, for instance during release of the pelvitrochanteric muscles, further manipulating with the extremity may result in squeezing the extracapsular part of the MFCA deep branch in space between the external obturator muscle and the quadratus femoris muscle. Thus bleeding from the artery is temporarily stopped, but it will reappear due to joint reduction at the end of surgery. In addition, hip external rotation and adduction may push the artery deeper between the muscles mentioned above. To treat such a situation is then very difficult. When the artery is injured, we recommend treatment by ligature. We proceed in the following way: We identify the exact site of bleeding by placing the extremity, before component implantation, in a neutral position. Using a bone hook, we gently put the femur in a lateral position and do external rotation without adduction. At the identified site of bleeding, we compress the artery with a Mikulicz clamp. Subsequently, we move the limb to adduction and external rotation and through ligature we try to intercept the arterial trunk in a position in which it passes between the quadratus femoris muscle and the external obturator muscle. In case we do not succeed to intercept the injured artery, we make a ligature that contains both the muscles and the artery. CONCLUSIONS The relevant literature has not provided information on how to treat the MFCA injured during total hip replacement surgery carried out from the anterolateral approach. Our experience has shown that, during release of the capsule and pelvitrochanteric muscles, the deep branch of the MFCA can be damaged. This intra-operative injury of the MFCA may produce serious bleeding difficult to stop. The resultant blood loss may complicate the post-operative outcome. Therefore, a good understanding of the extracapsular course of the deep MFCA branch can reduce the risk of arterial injury and may aid in a correct treatment of the injured vessel and elimination of the associated blood losses.

• MeSH
• anatomie topografická MeSH
• arteria femoralis anatomie a histologie   chirurgie   patologie   MeSH
• arterie anatomie a histologie   chirurgie   zranění   MeSH
• financování organizované využití   MeSH
• krvácení chirurgie   komplikace   krev   MeSH
• náhrada kyčelního kloubu metody   MeSH
• výkony cévní chirurgie metody   přístrojové vybavení   využití   MeSH

We assessed the long-term results of 58 Souter-Strathclyde total elbow replacements in 49 patients with rheumatoid arthritis. The mean length of follow-up was 9.5 years (0.7 to 16.7). The mean pre-operative Mayo Elbow Performance Score was 30 (15 to 80) and at final follow-up was 82 (60 to 95). A total of 13 elbows (22.4%) were revised, ten (17.2%) for aseptic loosening, one (1.7%) for instability, one (1.7%) for secondary loosening after fracture, and one elbow (1.7%) was removed because of deep infection. The Kaplan-Meier survival rate was 70% and 53% at ten and 16 years, respectively. Failure of the ulnar component was found to be the main problem in relation to the loosening. Anterior transposition of the ulnar nerve had no influence on ulnar nerve paresthaesiae in these patients.

• MeSH
• artroplastiky kloubů metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• loketní kloub chirurgie   patofyziologie   MeSH
• následné studie MeSH
• nestabilita kloubu chirurgie   MeSH
• pooperační komplikace chirurgie   MeSH
• pronace fyziologie   MeSH
• protézy kloubů MeSH
• reoperace MeSH
• revmatoidní artritida chirurgie   patofyziologie   MeSH
• rozsah kloubních pohybů MeSH
• selhání protézy MeSH
• senioři MeSH
• supinace fyziologie   MeSH
• ulna chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH