POSTER ABSTRACTS - ISAKOS

subsidence and revision rate. Malpositioning of
components can result in abnormal soft tissue
balancing, asymmetrical stress rising and
maltracking. Malposition of the ulnar component
in varus direction and positioning of the humeral
component in extension resulted in more
radiographic loosening and a higher revision rate.
In order to reduce revision rate and improve
results of TEP a better alignment of the
components during insertion of the prosthesis
must be achieved . Maybe computer assisted
surgery can solve this problem in the future.
E-poster #202
Viscosupplementation Not Effective for the
Treatment of Posttraumatic Osteoarthritis of
the Elbow
Richard van Brakel, Nijmegen, NETHERLANDS,
Presenter
Denise Eygendaal, Nijmegen, NETHERLANDS
Sint Maartenskliniek, Nijmegen, NETHERLANDS
The treatment of posttraumatic osteoarthritis of
the elbow in young patients remains a challenge.
The current conservative options of treatment are
analgetics and intra-articular injection of
corticosteroids. No studies are available in which
the results after viscosupplementation in the
elbow are evaluated. In this prospective cohort
study, we have evaluated the effect of hyaluronic
acid on pain and function of the posttraumatic
osteoarthritic elbow-joint. In this prospective
cohort study, we evaluated the effect and safety of
viscosupplementation in 20 elbows with
posttraumatic osteoarthritis of 19 patients (9
male, 10 female, average age 47,1 years, SD: 15,8
years). Three injections with sodium hyaluronate
were given within four weeks with regular
intervals. Evaluation took place just before the
first injection as well as after three and six months
and consisted of the Elbow Function Assessment
Score, the Functional Rating Index by Broberg and
Morrey and the Modified Andrews Elbow Scoring
System. Pain was also assessed by means of
Visual Analogue Scales. Only pain showed a slight
(but not significant) decrease 3 months after
starting viscosupplementation. Other parameters
were not influenced by treatment with
viscosupplementation at any time. Systemic or
local adverse effects did not occur. Because the
use of viscosupplementation for the treatment of
posttraumatic osteoarthritis of the elbow provides
only slight (but not significant) short-term pain
relief while other parameters were not modified,
we believe that viscosupplementation is not
suitable for this indication. Different rheological
properties of the synovial fluid in posttraumatic
osteoarthritic joints in comparison to that in
degenerative osteoarthritis may explain the
ineffectiveness of intra-articular injections with
sodium hyaluronate.
E-poster #203
Results of the Kudo Total Elbow Arthroplasty in
Patients with Sever Destruction of the Elbow
Joint due to Rheumatoid Arthritis
Rinze Reinhard, Nijmegen, NETHERLANDS,
Presenter
Margarita van der Hoeven, Nijmegen,
NETHERLANDS
Maarten de Vos, Nijmegen, NETHERLANDS
Denise Eygendaal, Nijmegen, NETHERLANDS
Sint Maartenskliniek, Nijmegen, NETHERLANDS
Despite increased experience with total elbow
arthroplasty there is no consensus whether to use
an unconstrained or semi-constrained prosthesis
in severely destructed elbow joints. In this study
we evaluated the results of the Kudo type-4
unconstrained total elbow prosthesis in severely
destructed elbows. From 1990 to 1997 fifty-seven
elbows in forty-five patients with rheumatoid
arthritis (RA) underwent a primary, non-cemented
total elbow arthroplasty with use of the Kudo
type-4 prosthesis. All elbows were graded as
Larsen III, IV or V. After an average of 7 years (4.4-
11.2) thirty-four patients (44 elbows) were
available for clinical follow-up. The Mayo Clinic
Performance Index for the elbow (MCPI) was used
to classify the results. Anteroposterior and lateral
radiographs of the operated elbow were obtained
in a standardised way at follow-up examination.
According to the MCPI twenty-nine elbows were
excellent or good and four were fair or poor. Four
elbows had a limited range of motion and one
patient had a superficial infection. Ulnar
neuropathy occurred in 9 patients; 4 were
operated additionally. Thirteen elbows (30%)
needed a revision procedure for ulnar loosening
(7), fractured humeral components (5) and for a
fractured ulnar component (1). No (sub)luxations
were seen. Kudo unconstrained type-4 total elbow
arthroplasty generally results in acceptable scores
and function, without dislocation or instability.
However, our study confirms high rates of ulnar
neuropathy and revision procedures. Fatigue
breakage of the humeral stem seems to be
overcome by the development of the Kudo type-5