arthroplasty
Background
Indications
RA
OA
AVN
Contra-indications
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
Osteoarthritis
Epidemiology
Usually after 50-60 years of age
Aetiology
Primary 90% of cases
Secondary
- AVN
- trauma
- instability
Pathology
Ankle Arthroplasty
History
First generation (late 70s early 80s)
Results
Forefoot
Issues
1. Painful Bunion / Hallux valgus
2. Metatarsalgia / MTPJ dislocation
3. Claw toes
Distal Humerus Fractures
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
- 40o anterior angulation in sagittal plane
Arthroplasty
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
Rheumatoid Arthritis
Epidemiology
50% rheumatoid patients have elbow pathology
- 80% also have shoulder pathology
- 90% hand and wrist
Always consider entire upper limb