Background
Indications
RA
OA
AVN
Contra-indications
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
RA
OA
AVN
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
First generation (late 70s early 80s)
Results
Darrach's
- distal ulna excision
- best for elderly RA patient
Bower's interpositional hemiarthoplasty
Technique
Ulna drift & volar dislocation
Ulna Drift / Ulna Dislocation
1. Physiological
Rotator cuff
- often deficient
Bone stock
- often deficient
Glenoid
- often posterior version
1. TSR
Indications
- cuff intact
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