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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2003 August;54(4):289-95
Indications for total elbow replacement
Stanley J. K., Sharpe K. R.
Upper Limb Unit, Wrightington Hospital Wigan, UK
Total elbow replacement is becoming a much more common operation undertaken to treat elbow pathologies. Careful patient selection is important to ensure good results of surgery and that arthroplasty is the most appropriate treatment. This is the last resort in the treatment of elbow pathologies and needs to be recognised as such. There are also specific contraindications such as active infection and relative ones such as previous infection. The group of rheumatoid patients is well served by total elbow replacement. As long as full conservative therapy has been exhausted then there are few bars to proceeding. The patients with primary osteoarthritis are generally more active and younger. They need carefull selection to avoid difficult problems in the future. Generally the patient needs to be older, and of lower demand. Full conservative methods need to be attempted including interpositional arthroplasty where indicated. As to traumatic conditions there is complex interplay between age, underlying desease, severity of injury, sex and level of physical demand that leads to a decision to offer total elbow replacement in these cases. The indications for arthroplasty in ankylosis are limited and goals need to be clearly defined between the physician and patient. As to other pathologies including tumour, the usual processes of decision making still apply but where a regional excision is necessary then a custom prosthesis is often required.