Les prothèses totales de coude

This first SOFCOT symposium devoted to first-intention total elbow prostheses collected a total of 370 total elbow prostheses, 321 in rheumatoid arthritis patients and 49 in trauma patients. Among the rheumatoid arthritis patients, there were 227 (81.3%) women and 52 (18.7%) men. Mean age at implantation was 57 years. Four types of prostheses were used: 136 GSBIII, 108 Guepar (59 G1, 20 G2, 28 G3), 42 Kudo, and 35 Coonrad-Morrey. At mean follow-up which varied from three to five years, the elbows were totally or nearly totally pain free with joint motion near 100°. The elbows were stable (except with G1 prostheses) with satisfactory function of the homolateral upper limb. The Mayo Clinic total score varied from 71 points for G1 prostheses to 93 for Coonrad-Morrey prostheses. Good or excellent outcome was reported for 68% of the Kudo prostheses and 100% of the G3 prostheses. Radiologically, lucent lines were often limited to a single zone. Humeral lines were generally the same for the different types of prostheses while ulnar lines were significantly different among the semi-contrained prostheses, the GSBIII prostheses having more ulnar lines than the Coonrad-Morrey prostheses. There were more cases of humeral migration for the G1, G2, and Kudo prostheses than for the others. Two types of implants presented fractures: 9.5% humeral fractures for the Kudo prostheses and 2.9% ulnar fractures for the Coonrad-Morrey prostheses. Complications before the sixth week occurred in 13% of patients, mostly ulnar nerve involvement in 7%, wound dehiscence in 2.5%. After the sixth week, 4 (1.3%) late infections were observed. Bone complications were frequent and inversely proportional to implant constraint. Planned revision varied from 0% for G3, 3% for Coonrad-Morrey, and 7% for GSBIII to 33% for Kudo. The survival analysis showed that the risk of loosening was greatest with the Coonrad-Morrey implant and that the risk of instabilitiy was greatest for the Guepar implants. This complication appears to have been resolved with the G3 version due to systematic use of a radial head prostheses. Semi-constrained elbow prostheses were also used for 49 trauma victims, mostly women (81.25%). The sex-ratio was 4.33:1. Mean age at surgery was 69.77 years. Two types of prostheses were used: Coonrad-Morrey for 45 patients and GSBIII for four. Indications were: recent fractures of the distal humerus (n = 21), nonunion of the humeral palette (n = 10), posttraumatic degenerative disease (n = 12), chronic instability (n = 6). Two groups were analyzed: group 1 included patients treated for recent fracture and nonunion (n = 31 elbows) and group 2 patients treated for posttraumatic degenerative disease with chronic instability (n = 18 elbows). At mean follow-up of 17.4 months, outcome in group 1 (Mayo Clinic score) was excellent or good in 80%. The total Mayo Clinic score was 82.5 points and the DASH score was 55 points. Five complications (16%) were noted in this group, with surgical revision required for three patients (10%). In this group none of the implants were replaced. In group 2, mean follow-up was two years and the results were considered excellent or good in 77%. The total Mayo Clinic score was 75.3 points, and the DASH score 46.7 points. Nine patients (50%) presented complications, five leading to revision (28%). There was one failure due to disassembly of a GSBIII implant which was replaced. For trauma victims, the Coonrad-Morrey implant appears to be a reliable therapeutic solution for selected patients providing a high level of patient satisfaction when other options have to be ruled out. With this technique, patients recover a pain-free elbow with satisfactory joint motion.