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Synovectomy of the elbow and radial head excision in rheumatoid arthritis Predictive factors and long-term outcome Gendi NS; Axon JM; Carr AJ; Pile KD; Burge PD; Mowat AGJ Bone Joint Surg Br 1997[Nov]; 79 (6): 918-23We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were revision surgery (performed or desired) and/or the presence of significant or severe pain. The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per year. The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compared. A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04). At review, there was a mean gain of 50 degrees in supination-pronation and 11 degrees in flexion-extension; both correlated with success. Failure correlated with recurrence of synovitis, elbow instability, ulnar neuropathy, poor general mobility and poor upper-limb function. The last was independently affected by the severity of RA in the ipsilateral shoulder. Our findings show that although the short-term result of ES and RHE in rheumatoid arthritis is good, the long-term outcome is poor except in a subgroup with more than 50% limitation of forearm rotation.|*Synovectomy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Arm/physiopathology[MESH]|Arthritis, Rheumatoid/physiopathology/*surgery[MESH]|Elbow Joint/physiopathology/*surgery[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Forecasting[MESH]|Humans[MESH]|Joint Instability/etiology[MESH]|Longitudinal Studies[MESH]|Male[MESH]|Middle Aged[MESH]|Osteotomy[MESH]|Pain, Postoperative/etiology[MESH]|Peripheral Nervous System Diseases/etiology[MESH]|Pronation/physiology[MESH]|Radius/*surgery[MESH]|Range of Motion, Articular/physiology[MESH]|Recurrence[MESH]|Reoperation[MESH]|Retrospective Studies[MESH]|Shoulder Joint/physiopathology[MESH]|Supination/physiology[MESH]|Survival Analysis[MESH]|Synovitis/etiology[MESH]|Treatment Failure[MESH]|Treatment Outcome[MESH]|Ulnar Nerve/physiopathology[MESH] |
