Indications have narrowed
- due to success of shoulder arthroplasty
1. Chronic infections of GHJ
2. Stabilization in paralytic disorders
3. Post-traumatic brachial plexus palsy
4. Salvage of failed GHJ Arthroplasty
- may need bone graft procedures
5. Arthritic diseases unsuitable for arthroplasty / young patient
Replant
- reattachment of body part that has been completely severed
Revascularisation of incomplete Amputation
1. Removal Loose body
2. Excison of osteophytes
- coronoid
- olecranon
- aiming to improve ROM / prevent impingement
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
Very few
- young labourer with severe disabling elbow pain
- trial in POP at 90o for 6 weeks
Poor function
- adjacent joints cannot compensate for loss of function
RA
- high failure rate especially flail elbow with poor bone stock
Like elbow arthrodesis, knee arthrodesis is an option of last resort
Example
- cannot sit on airplane toilet with door closed
Coapt 2 coplanar cancellous surfaces under compression with rigid fixation
Septic arthritis
Salvage failed TKR / infected TKR
Tumour
Charcot Join
PFFD
Severe LBP
- most common indication
Ipsilateral knee pain
- less beneficial
Malposition
- especially abduction
Absent abductor mechanism
Flail
Active infection
Insufficient bone stock
LLD
Femur
- removal of femoral head cartilage
- resurfacing with metal
- cemented / uncemented
Acetabulum
- standard technique
Bearing surface
- metal on metal
Relatively young man (40 - 50)
OA
Young adult
- 16 - 30 years old
- monoarticular disease
- heavy demand
Exhausted options of osteotomy
- risk of THA failure / multiple revision surgeries considered too high
Maximise bony contact
Minimise shortening
Average age 6 years
20% distal humeral fracture
- second most common elbow fracture after supracondylar
Pull Off
- more common
- fracture begins posterolateral metaphysis
- LCL, ECRL & ECRB attached to fragment
Push off
- varus force to extended EJ