Disease activity and the course of elbow joint deterioration over 10 years in the patients with early rheumatoid arthritis

Accuracy of Implant Placement Based on Three-Dimensional Preoperative Planning in Total Elbow Arthroplasty

Background: Accurate implant placement in the optimal position is important to obtain favourable clinical outcomes and prevent complications in total joint arthroplasty. We aimed to assess the accuracy of implant placement based on three-dimensional (3D) preoperative planning for unlinked total elbow arthroplasty (TEA) and to clarify the effect of implant placement on clinical outcomes. Methods: This study included 20 patients (22 elbows, 17 with rheumatoid arthritis and 5 with osteoarthritis, with a mean follow-up period of 47 months) who underwent TEA with an unlinked-type implant after computed tomography (CT)-based 3D preoperative planning. Implant placement was planned preoperatively and several parameters were set to reflect it intraoperatively. TEA was performed based on the plan, and postoperative CT was conducted to evaluate differences in implant placement by comparing the preoperative plan and postoperative implant placement. Furthermore, we evaluated the relationship between implant placement differences and postoperative clinical outcomes, including range of motion, Visual Analogue Scale, Mayo Elbow Performance Score 1 year after surgery and complications at the last follow-up. Results: The mean absolute translation was within 2 mm, the mean absolute tilt was within 4°, the mean absolute rotation of the humeral component was within 4° and the mean absolute rotation of the ulnar component was 10.2° ± 6.8°. In the ulnar components, 15/22 (68%) cases were externally rotated, and the mean external rotation was 7.1° ± 10.2°. We defined the absolute ulnar component's rotational difference of more than 10° as a 'malrotation' group (n = 8) and 10° or less as a 'control' group (n = 14). We compared the clinical outcomes between both groups, however, no significant differences were observed in clinical outcomes and complications. Conclusions: We observed notable malrotation in the postoperative positioning of the ulnar component. Intraoperative support devices may be necessary to accurately reproduce the preoperative plan in the surgical field. Level of Evidence: Level IV (Therapeutic).

Rheumatoid elbow

The elbow is often involved in the progression of rheumatoid arthritis. Because of the elbow's unique role in maneuvering and positioning the hand in space, loss of normal elbow motion, loss of stability, or increased pain with the use of the elbow are all significant sources of impairment in patients with rheumatoid arthritis. The improvements in disease-modifying medications have greatly diminished the prevalence of severe elbow degeneration among patients with rheumatoid arthritis. However, it hasn't been eliminated. In this article the authors discuss strategies for managing it.

Radiographic measurements in the evaluation and classification of elbow joint destruction in patients with rheumatoid arthritis

We developed two new radiographic parameters-the humeral surface height ratio and ulnar surface height ratio-to precisely detect changes in the bony structure of rheumatoid elbows. Of the 59 patients with rheumatoid arthritis, 101 elbows were classified into four types (osteoarthritis, ankylosis, erosive, and resorptive) according to the radiographic appearance. Clinically, osteoarthritis type and ankylosis type were considered to be stable form, and erosive type and resorptive type were unstable form. Patients' clinical data and yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio were compared among the four types and between the two forms. There were significant differences between the two forms and among the three types except for the ankylosis type in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio. Stable and unstable forms were distinguished by a cut-off point of 0.65 and 2.58 in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and the ulnar surface height ratio, respectively. These parameters might be useful for monitoring the structural changes of the elbow joint in rheumatoid arthritis.

Tight control is important in patients with rheumatoid arthritis treated with an anti-tumor necrosis factor biological agent: prospective study of 91 cases who used a biological agent for more than 1 year

The purpose of this study is to identify the factors that require arthroplasty due to the progression of joint destruction, even when an anti-tumor necrosis factor (TNF) biological agent is used for rheumatoid arthritis (RA). Among 91 cases that used the anti-TNF biological agent for more than 1 year, two groups of 21 cases that resulted in arthroplasty (surgery group) and 70 cases that did not result in arthroplasty (non-surgery group) were compared and examined. When the anti-TNF biological agent was first administered, disease activity and internal use of glucocorticoid (PSL) were not different in these two groups. The average DAS28-CRP(4) (disease activity score including a 28-joint count/C-reactive protein) (p < 0.001) and the amount of internal use of PSL (p < 0.05) were significantly decreased in the non-surgery group compared with the surgery group at the final survey. To inhibit the need for joint surgery in patients using the anti-TNF biological agent, it is important to maintain tight control over RA activity.