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PubMed1977

Joint surgery for rheumatoid arthritis.

The state of the art in the surgery of rheumatoid joint disease is discussed with emphasis on guidelines for choosing the patients and the types of procedures available. Strong-willed, strong-boned, strong-muscled, and well-informed patients are the best candidates. Synovectomy is particularly useful in the minimally erosive stages of the disease when the active synovitis is not suppressed by one or more steroid injections or other modalities of therapy. Arthrodeses and arthroplasties are midstage procedures that are now being supplanted by total joint replacement. This is especially true of the knee, but new prostheses for elbows, shoulders, wrists, and ankles are on the horizon.

Ankle Joint↗
PubMed1987

Capitellocondylar total elbow arthroplasty. Two-to eight-year experience.

A series of 35 capitellocondylar total elbow arthroplasties was performed on 29 patients. The average patient age at the time of surgery was 58 years (range, 28-71 years). Follow-up study averaged 5.6 years (range, 2-8 years). The complication rate was 57%. There were three infections, three dislocations, and two intraoperative fractures. Transient ulnar nerve palsy occurred in nine patients, postoperative hematomas in two patients, and intraoperative perforation of the ulna cortex in one patient. Aseptic loosening occurred around the humeral component of one elbow. No ulnar components developed aseptic loosening. Range of motion increased in all planes, except extension. Pain relief was achieved in all but one patient. There were no unstable elbows.

Adult↗
PubMed1985

The role of non-prosthetic surgery in the treatment of rheumatoid arthritis by fusions and auto-arthroplasties. Current practice at the Rheumatism Foundation Hospital, Heinola.

After the introduction of modern artificial joints the classical operation methods, such as osteotomies, arthrodeses and auto-arthroplasties, have been forced aside little by little. Irrespective of the late complications following replacement surgery, the patients today expect a movable, painless endoprosthesis, which at it best seems to benefit the patient. The question arises whether the classical methods still have a role in the surgical treatment of rheumatoid arthritis. The reply is "yes", they do have a fair share of rheumatoid surgery, indeed. They still compete with the modern endoprosthetic surgery for the place of the primary operation in many cases. To give instances, tarsal reconstruction by subtaloid arthrodesis is superior to other methods and arthrodesis of the wrist is often only reasonable way to get a strong, painless key joint to the hand. Even the shoulder arthrodesis may successfully compete with an endoprosthesis. Also classical auto-arthroplasties such as resection arthroplasties of the metacarpophalangeal and elbow joints are serious rivals of respective endoprostheses. The practice of Rheumatism Foundation Hospital (RFH) in the golden mean between the endoprosthesis enthusiasts and their opponents will be described in this article. The practice varies greatly from clinic to clinic and is progressing--and regressing--all the time.

Ankle Joint↗
PubMed1979

Differential bone-scanning in the evaluation of a painful total joint replacement.

In an attempt to differentiate between loose and infected total joint replacements, seventy-nine patients were studied with both technetium-99 pyrophosphate and gallium-67 citrate bone scans. Seventy of these patients had positive technetium scans. Nineteen had positive gallium scans and all nineteen had positive cultures at the time of operation, while one patient had a false-negative gallium scan. Ten other patients who had negative technetium-99 scans and a painful total joint were followed without operative intervention. Of these, only two required operation after their technetium-99 scans became positive. Based on these studies, gallium-67 citrate scans combined with technetium-99 pyrophosphate scans are believed to be useful in differentiating between loose and infected prostheses. A negative technetium scan should weigh heavily against surgical exploration in an attempt to find the source of pain.

Aged↗
PubMed1981

Comminuted fractures of the radial head. The role of silicone-implant replacement arthroplasty.

Radial head resection is the accepted treatment of comminuted radial-head fractures in adults, but the results are not always satisfactory. This study examines the results of silicone replacement arthroplasty of the radial head in acute fractures and as a salvage procedure after failed resections of the radial head. The first group of patients was evaluated both before and after silicone replacement arthroplasty had been done as a salvage procedure following a previous radial head fracture. This group comprised twelve patients with an average follow-up of 3.8 years. Improvement was found in a number of parameters, including supination and grip strength. The second group of patients had had a primary silicone replacement arthroplasty following a comminuted radial-head fracture. This group was composed of six patients with an average follow-up of 3.6 years. The radial head implant was found to provide a spacer effect that maintained good radiocapitellar contact and prevented radial shortening. Silicone replacement arthroplasty has a role as a useful, safe, and reliable alternative in the treatment of comminuted radial-head fractures in adults and as a salvage procedure in patients with failed radial-head resections. This is especially true in young, active individuals, who were found to be at the greatest risk of failure after radial head resection alone. This was attributed to greater demands being placed on the involved extremity.

Adolescent↗
PubMed1980

Myoelectric prosthetic fitting in young children.

Fitting myoelectrically controlled hand prostheses to young children has previously been considered unrealistic and even contraindicated. In 1971 the first preschool child was supplied with a myoelectric prosthesis at the Regional Hospital in Orebro, Sweden. A total of 40 young unilateral below-elbow congenital amputee children have thus far been fitted. The youngest children were 16 months of age when fitted. Such prostheses are clearly better integrated and accepted by children than by most adults. However, certain condiderations must be taken into account: the stump parameters ought to be suitable and the fitting done by a skilled team; the training must be properly followed up in close cooperation with the parents, who should be thoroughly and adequately informed; possibilities of prosthetic adjustments and rapid repairs should be mentioned; and psychological factors must be carefully evaluated. Under these conditions a very early myoelectric prosthetic fitting can be expected to greatly benefit the individual.

Age Factors↗
PubMed1976

[Total replacement of humerus including shoulder and elbow joints].

A case of total alloplastic replacement of the humerus, including the neighboring joints, is reported. The method may be used for treatment of large defects of the humerus due to tumor, osteomyelitis, or trauma. The alloplastic replacement seems superior to autoplastic fibula transplantation.

Bone Neoplasms↗
PubMed2005

Ipsilateral shoulder and elbow replacements: on the risk of periprosthetic fracture.

BACKGROUND: Ipsilateral shoulder and elbow replacements may leave only a short segment of bone bridging the two implants in the humerus. The potential for high stress concentrations as a result of this geometry has been a concern with regard to periprosthetic fracture, especially with osteoporotic bone. The study aims to determine the optimum length of the bone-bridge between shoulder and elbow humeral implants, and to assess the effect of filling the canal with cement. METHODS: A three-dimensional finite element model was used to compare the stresses between a humerus with a solitary prosthesis and a humerus with both proximal and distal cemented prostheses. The length of the bone-bridge and the effect of filling the canal with cement were studied under bending and torsion. FINDINGS: Gradual load transfer from prosthesis to bone was observed for all cases, and no stress concentration was evident. The length of the bone-bridge had no deleterious effect on stresses in the humerus, and filling the canal with cement did not appreciably decrease the loads carried by the humerus. INTERPRETATION: The length of the bone-bridge between stem tips has little effect on the resultant stresses in the humerus. Filling the canal with cement adds little benefit to the structural integrity of the humerus. Ipsilateral shoulder and elbow prostheses may be considered independent of one another in terms of risk of periprosthetic fracture.

Computer Simulation↗
PubMed1997

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.

We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.

Accidental Falls↗
PubMed1983

A field evaluation of arm prostheses for unilateral amputees.

A post-clinical investigation has been carried out among 42 unilateral amputees who lost their hand due to an accident. The investigation was directed at two main topics of interest. Firstly the amputee, the problems he has to cope with, and the role the prosthesis plays in his life; and secondly the prosthesis, its use and its potential benefits and burdens. The group of amputees consisted of above-elbow and below-elbow amputees. Body powered as well as myoelectric prostheses were represented in the group. Most of the information was obtained during a two-day home visit where a semi-structured interview was conducted, and where a number of daily life activities were observed. The information thus obtained has led to a number of conclusions and recommendations with respect to the rehabilitation of this category of amputees, and with respect to the design criteria of prostheses for unilateral amputees.

Activities of Daily Living↗
PubMed1983

[Musculocutaneous flaps for increased load capacity of the above-elbow stump].

Above-elbow amputations for severe injury or fourth degree burns may leave an unsatisfactory stump. Fitting of a prosthesis is always difficult. Similar difficulties may arise with congenital transverse absence, while all childhood amputations have the potential problem of bony overgrowth threatening to penetrate skin. Because the stump is already too short, re-amputation is not an acceptable solution. We recommend improvement of such stumps by the transfer of a latissimus dorsi musculocutaneous flap. The principles and details are discussed.

Amputation Stumps↗