1. Significant functional impairment
2. PIPJ contracture
- originally thought to intervene early
- Macfarlane showed residual FFD always about 30o
- may need to release check rein ligaments / accessory collateral ligaments
3. MCPJ contracture >30o
4. Trigger fingers
- must do limited fasciectomy
UKA is intended to be load sharing
- correct to neutral or slight varus
HTO is a load-shifting / load-sparing procedure
- over correct into valgus
Advantages UKA
1. Rapid rehabilation
Trauma
Meniscectomy
Osteonecrosis
Varus or valgus malalignment
Relief of pain
Improve function
No loss of ROM
No or slight restriction of activity
Allow heavy functional demands
Placing patient into a strong magnetic field
- 30 000 x stronger than the earth's magnetic field
Stronger magnets, better images, shorter times
- 1.5 Tesla
- 3 Telsa
The nuclei of elements with odd numbers of protons line up
- i.e. hydrogen atoms
- hydrogen is plentiful in fat and water
A radiofrequency is then applied, exciting the protons
Replant
- reattachment of body part that has been completely severed
Revascularisation of incomplete Amputation
1. Removal Loose body
2. Excison of osteophytes
- coronoid
- olecranon
- aiming to improve ROM / prevent impingement
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
Very few
- young labourer with severe disabling elbow pain
- trial in POP at 90o for 6 weeks
Poor function
- adjacent joints cannot compensate for loss of function
RA
- high failure rate especially flail elbow with poor bone stock
Severe LBP
- most common indication
Ipsilateral knee pain
- less beneficial
Malposition
- especially abduction
Absent abductor mechanism
Flail
Active infection
Insufficient bone stock
LLD
Young adult
- 16 - 30 years old
- monoarticular disease
- heavy demand
Exhausted options of osteotomy
- risk of THA failure / multiple revision surgeries considered too high
Maximise bony contact
Minimise shortening