INFO - The rheumatoid elbow: current concepts and controversies

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The rheumatoid elbow: current concepts and controversies.

Current Opinion in Orthopedics. 14(4):302-306, August 2003.

Connor, M. MD *; Lundeen, Gregg A. MD +

Abstract:

The orthopaedic management of the rheumatoid elbow continues to be a

challenging and difficult problem. Although the medical management of

rheumatoid arthritis continues to improve, the surgical alternatives of

synovectomy, capsular release, radial head excision, and total elbow

arthroplasty each have their own very important place in the successful

comprehensive management of the rheumatoid elbow. As arthroscopic management

of orthopaedic conditions in general continues to evolve and improve, so do

the results of arthroscopic management of the recalcitrant symptomatic

rheumatoid elbow. Total elbow arthroplasty continues to represent an

exceptionally successful alternative for the treatment of the severely

affected rheumatoid elbow. Linked, semiconstrained and unlinked resurfacing

elbow arthroplasties are available, and each has their proponents. Based on

the current orthopaedic literature available, the linked, semiconstrained

implants overall have a slightly less complication rate, higher patient

satisfaction, and greater survivorship than the resurfacing designs.

However, a well-performed prospective, randomized, blinded trial comparing

these two types of implants has not yet been performed. The orthopaedic

surgical management of the painful rheumatoid elbow continues to evolve.

Arthroscopic synovectomy and capsular release without a requisite radial

head excision has great clinical advantages and may likely soon represent

the procedure of choice over the more traditional open approach. Total elbow

arthroplasty using a linked, semiconstrained implant currently represents

the most effective arthroplasty alternative considering complication rate,

clinical success rate, and implant survivorship. Continued basic science and

clinical research efforts are ongoing in the areas of total elbow

arthroplasty design.

© 2003 Lippincott & Wilkins, Inc.

http://www.co-orthopedics.com/pt/re/coortho/abstract.00001433-200308000-00015.ht\

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