Introduction

In 2011 the Scottish Government published national MRSA screening requirements. A comparison of Orthopaedic and ENT elective surgery intended to juxtapose a specialty known to take MRSA screening seriously with one that has little clinical concern with regards MRSA infection. ENT surgery parallels Orthopaedics in using implants and there potentially being MRSA colonisation at or close to the site of surgery. In Orthopaedics MRSA infection is infrequent, but implant infection with antibiotic resistant bacteria has a particularly poor prognosis. In ENT MRSA infection is rare and colonisation does not influence patient care.

The Souter-Strathclyde total elbow has been used in our unit since 1989. The current study reviews the results of the first 10 years of practice and compares them with reported results. Pain relief, complication rate, functional outcome and patient satisfaction were evaluated.

The primary indication for replacement was pain in the presence of advanced rheumatoid destruction of the joint on radiography, classified according to Souter (1989). Complications had been dealt with as appropriate, reviewed retrospectively and classified according to Dent et al (1995). Pain, activities of daily living and overall satisfaction were assessed by questionnaire. They were measured clinically for range of movement, power, stability and elbow performance using the Mayo Elbow Performance Score. Follow up x-rays were assessed for evidence of loosening. Fifty elbows were replaced in 43 patients, 34 female and nine male. There were 24 right and 26 left elbows. All patients had rheumatoid arthritis; one patient had an associated traumatic injury to the elbow. The pre-operative radiographs available for review were 10 grade 3, 12 grade 4 and 17 grade 5. The mean age of the patients was 65 years (range: 33–83 years). The average follow up was five years (range: 1-10 years). Fourteen patients died and one was lost to follow up, leaving 33 elbows in 28 patients. There were 12 complications, eight were type A, four elbows had a transient radial palsy, three had ulnar neuritis and there was one pressure sore. The only type B complication was a persisting subluxation in extension. There were three type C complications with early revision, a humeral fracture revised to a humeral resection implant, a subluxated joint revised to an ulnar retentive prosthesis and one deep infection revised to an excision arthroplasty. Twenty-four had no pain, six had occasional pain, one got pain with heavy use and two had pain at night. For ADL, two patients could not reach their mouth with difficult feeding and five had trouble toileting. All were able to dress themselves and turn taps. The preoperative range motion was 110° (±23.1°) Flex., 40° (±11.5°) Ext., 45° (±12.2°) Pron., and 46° (±36.9°) Sup. Postoperatively the mean ranges were 131° (±13.1°) Flex., 32° (±16°) Ext., 81° (±14°) Pron. and 72° (±32°) supination. By the Mayo performance score 67% had excellent results, 8% had good results, 17% fair and 8% poor. 67% of patients were extremely pleased with their results and only one was dissatisfied. No elbows had radiological evidence of loosening requiring revision.

There was substantial pain relief and an increase in the range of motion. The number of complications was acceptable and the patient satisfaction level was very high. The Souter-Strathclyde elbow arthroplasty is an appropriate option in rheumatoid patients with elbow destruction.