Total Elbow Arthroplasty Follow Up 10 Years in Rheumatoid Arthritis, A Systematic Review/Meta-Analysis

Abstract Background Rheumatoid arthritis is the most common form of chronic inflammatory arthritis and affects about 1% of adults. It is characterized by progressive, symmetrical arthritis involving many joints, most commonly the knee, wrist and interphalangeal joints. The elbow is affected in between 20% and 65% of patients, often causing severe painful disability. In patients with severe arthritis, many forms of treatment are available to relieve pain and improve function. Total elbow arthroplasty is commonly performed for end-stage arthritis. However, Total elbow arthroplasty has inferior implant survival and higher complication rates compared with arthroplasties of other major joints. This is usually thought to be due to the high risks associated with Rheumatoid arthritis and the complex anatomy of the elbow joint. Aim of the Work The aims of this study were to report on the long term outcome of total elbow arthroplasty in patients with rheumatoid arthritis, and to identify factors that affect the outcome patients satisfaction. Patients and Methods We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2005 and March 2020. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim is to identify the overall complication rate, associated risk factors and clinical performance. A meta- regression analysis completed to identify the association between each parameter with the outcome. The initial literature search resulted in 4776 studies, with 4665 duplicates subsequently removed. The remaining 111 studies were screened using our exclusion criteria. Following application of our exclusion criteria, the full texts of 111 studies were thereafter evaluated with our inclusion criteria to screen for eligibility. Overall, 13 clinical studies including 349 elbows were included in this study Results According to the movement degree, flexion was recorded in 5 studies with 229 elbows and it was found that there was a significant difference in pre and post-operative groups (p < 0.001, I2 = 90%). Extension was recorded in 5 articles with 229 elbows. It was found that there was no significant difference in pre and post-operative groups (p = 0.12, I2 = 53%). Supination was recorded in 5 articles with 229 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.008, I2 = 79%). Pronation was recorded in 5 papers with 209 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.003, I2 = 83%). Conclusion Although elbow replacement is performed far less frequently than hip, knee, or shoulder replacement, its use is increasing and information for patients and clinicians on the longevity of implants and impact on quality of life is vital. Patients experienced a sustained improvement in pain and function for the 10 years following surgery.