replacement

Indications

RA 

OA 

AVN 

Contra-indications

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

History

First generation (late 70s early 80s) 

Results

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique

Deformity

Ulna drift & volar dislocation

Causes of MCPJ Deformity

Ulna Drift / Ulna Dislocation

1.  Physiological

Issues

Rotator cuff

- often deficient

Bone stock

- often deficient

Glenoid

- often posterior version 

Management

Options

1.  TSR

Indications

- cuff intact

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