Since 1974, a cementable, semi-constrained total wrist prosthesis has been implanted in patients with advanced destruction of the carpus usually secondary to rheumatoid arthritis. The single most common problem observed after surgery in the first one hundred cases was that of ulnar deformity. Since 1977, 25 total wrist arthroplasties have been performed in 22 patients (3 bilateral cases). A modification of the original prosthesis was employed in these. The newer designs allow for the precise reduplication of the instant center of motion of the normal wrist. Additionally, in the last six patients operated on, methylmethacrylate cement was not used to secure the metacarpal component because a secure press-fit was possible in each case. To date, postoperative results have disclosed no cases of radial ulnar imbalance. No cases of dislocation, infection, or loosening have occurred. No difference in the degree of postoperative pain relief has been observed between those cases in which cement was employed to secure the prosthetic components and those cases in which cement was used only to secure the radial component.

Adult↗

PubMedDate not supplied

Total elbow arthroplasty: a clinical review of 30 cases employing the Mayo and AHSC prostheses.

Chronic synovitis of the elbow in rheumatoid arthritics that has not responded to four to six months of optimal nonoperative management should be treated by synovectomy even in the absence of significant intra-articular X-ray changes. When intra-articular damage is significant, an arthroplasty will not only relieve the pain, but may also provide a satisfactory range of motion. It is necessary to consider all the possible complications and the fact that technically, total elbow arthroplasty is a difficult operation to perform. Because of the potential for loosening, one might consider using an unconstrained device in the patient with adequate bone structure, reserving the semiconstrained devices for elbows with disintegrated bone tissues. The constrained prostheses should be used only for the most severely disorganized and unstable elbows.

Adult↗

PubMedDate not supplied

The use of methylmethacrylate as a temporary spacer following en bloc resection of the distal femur.

The current state of the art of prosthetic joint replacement permits sizeable segments of the appendicular skeleton to be resected and replaced with prosthetic components which are secured with methylmethacrylate cement. Occasionally it is necessary to resect a rather sizeable area of pathologic bone and to provide for some type of temporary fixation until a specially fabricated prosthetic component can be made available. Under such circumstances it is necessary to maintain length of the involved extremity, and provide for skeletal stability to the area of resection. Although external fixation offers a reasonable option, the employment of an internal type of fixation in the form of titanium mesh reinforced with methylmethacrylate cement seems more desirable. With this technique, the potential problem of pin track infection is avoided while space suitable to the dimensions of the prosthetic implant can be preserved.

Adult↗