arthroplasty

Indications

RA 

OA 

AVN 

Epidemiology

Usually after 50-60 years of age

Aetiology

Primary 90% of cases

Secondary

- AVN

- trauma

- instability

Pathology

History

First generation (late 70s early 80s) 

Results

Definition 

Disorder of immune system 

- antigen-antibody complexes

- stimulate release of proteolytic enzymes

- leading to vasculitis, synovitis and cartilage destruction

Characterised

Articular Effects

- synovitis

- ligamentous and capsular laxity

- cartilage destruction

- osseous erosion

Vasculitis

- rheumatoid nodules

Epidemiology

2 groups

- young patient with high velocity injury

- older patient with comminuted, osteoporotic fracture

In the second group fixation can be very difficult

Anatomy

Hinged Joint

- trochlea axis is centre of rotation

- 40^o anterior angulation in sagittal plane

Indications

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

Acute unreconstructable fracture > 60

Epidemiology

50% rheumatoid patients have elbow pathology

- 80% also have shoulder pathology

- 90% hand and wrist

Always consider entire upper limb