Elbow rheumatoid elbow: surgical treatment options

Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint. Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055

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“… 37 , 38 In order to postpone a TEA in younger and active patients, a (arthroscopic) debridement of the elbow might be warranted. 39 …”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Management of the failed radial head arthroplasty

et al. 2020

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“…Involvement of the elbow has been documented in 20-65% of RA patients (Studer and Athwal, 2011). Upon examination of the joint, elbow synovitis demonstrated by posterolateral joint swelling can be accompanied by rheumatoid nodules and olecranon bursitis (Sanchez-Sotelo, 2016). Restriction in the ranges of motion can be expected including the early loss of joint extension.…”

Section: Large Joint Involvementmentioning

confidence: 99%

Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view

Sharif

Jumah

et al. 2017

Clinical Anatomy

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Rheumatoid arthritis (RA) is the most common chronic autoimmune disease of the joints affecting close to 0.5-1.0% of the general population. Although the etiopathogenesis of RA remains elusive, the involvement of dendritic cells and type 17 T-helper cells appears to be pivotal in maintaining a state of chronic inflammation. RA is generally characterized by small joint involvement. A chronic inflammatory process leads to joint destruction and to tendon and ligament laxity and disintegration. These processes result in an imbalance of forces acting on the joints causing joint deformities including swan neck deformity, boutonniere deformity of the hands, flexion deformity of the wrist, lesser toe deformities, and others. In some instances, bony erosions subsequent to the RA disease process can result in life-threatening events including, for example, atlanto-axial subluxation, which can cause myelopathy and paralysis; and basilar invagination, which can cause brain stem injury and imminent death. Although less commonly involved, larger joints are not spared, as evidenced by the involvement of the elbow, hip, and shoulder joints in a sizable proportion of RA patients. The progression and prognosis of this disease entity are variable, guarded and dependent on the efficacy and response to treatment modalities employed. Inadequate management results in disease progression, which ultimately leads to joint erosion, destruction, deformities and substantial decrease in the functional quality of life. Clin. Anat. 31:216-223, 2018. © 2017 Wiley Periodicals, Inc.

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“…29 . Synovectomy has become the procedure of choice for rheumatoid patients with uncontrolled symptoms as it gives a good long-term outcome.…”

Section: Elbowmentioning

confidence: 99%