Background Swett¹ was the first to report a successful elbow synovectomy in chronic infection arthritis. Smith-Petersen et al.² added radial head excision for rheumatoid arthritis elbow synovectomy. However, the usefulness of radial head excision in elbow synovectomy was controversial.

Objectives This study was designed to clarify the usefulness of radial head excision in elbow synovectomy with rheumatoid arthritis.

Methods We performed elbow synovectomy for 19 patients (21 elbows) suffering from rheumatoid arthritis. There were 14 women and 5 men. Radial head excision (E group) was added in 7 patients (7 elbows) and radial heads retain (R group) was in 12 patients (14 elbows). Average age at the time of the surgery was 51.4 years in E group, and 52.8 years in R group. The follow up period averaged 6.4 years in E group and 9.1 years in R group.

We evaluated clinical results and radiological parameters preoperatively and final examination. Clinical results were evaluated include pain, range of motion, stability.

Pain score was classified 4 stages. (0: no pain, 3: severe pain). We defined instability as more than 20 degrees of varus-valgus motion with the elbow flexed 25 degrees. Radiographic parameters were measured the height of humerus (H) in anteroposterior radiograph, the thickness of olecranon (O) in lateral. The degree of joint destruction was elucidated by Larsen grade. We compared with preoperative and final examination in each group. Statistical analysis was performed by Wilcoxon singed-ranks test. A p value of less than 0.05 was considered to indicate a significant difference.

Results Pain was eliminated or improved in all patients at final examination. The average pain score changed 2.7 to 0.7 in E group and 2.5 to 0.3 in R group. The flexion contracture preoperatively was -42.5 degrees, and significantly improved to -26 degrees at final examination in E group. In R group, it was not significantly improved from -35.7 degrees to -30.1 degrees. The arc of flexion did not change after synovectomy both two groups (115 to 124 in E group, 122 to 115 in R group). One elbow in each group was considered to be unstable at final examination.

Larsen grade had deteriorated 1 grade or more in all elbows of each group. The value of H significantly decreased 8.4 mm to 3.9 mm in E group and 11.0 mm to 6.2 mm in R group. The value of O was significantly decreased 12.8 mm to 10.0 mm in E group and 13.7 mm to 11.7 mm in R group.

Conclusion Radial head excision improved flexion contracture without influences on pain, stability and radiographic change in elbow synovectomy with rheumatoid arthritis.

References

1. Swett PO. Synovectomy in chronic infection arthritis. J Bone Joint Surg 1923;3:110

2. Smith-Petersen MN, et al. Useful surgery procedures for rheumatoid arthritis involving joints of the upper extremity. Arch Surg. 1943;46:764–70

3. Brumfield RH, et al. Synovectomy of the elbow in rheumatoid arthritis. J Bone Joint Surg. 1985;67-A:16–20