Clinical and pathological perspectives on elbow arthritis and arthroplasty

Abstract

: The basic design of replacement arthroplasty components for treating arthritis in the hip, knee and shoulder had been established by the end of the 1970s/early 1980s. Replacement arthroplasty components for elbow arthritis were being developed at the same time, but a wide variety of designs were manufactured, and the basic design characteristics required for a successful elbow joint arthroplasty remain a matter of debate today. Whereas the number of total elbow joint replacements (TERs) performed for elbow fractures has increased steadily over recent years, the reverse is true in arthritis surgery where there has been a steady decline. We explain this in terms of how our understanding of the pathology and evolution of degenerative changes in the elbow over the past 40 years have influenced our perspectives on the design of elbow arthroplasty components for arthritis and the predilection of the degenerative changes for the lateral (radiocapitellar) compartment of the elbow joint. This has led to the concept of unicompartmental elbow replacement and development of components to resurface the lateral compartment of the elbow [lateral resurfacing elbow (LRE) arthroplasty]. We now believe that the future direction of elbow arthroplasty lies in the further development of components to resurface specifically only those areas of articular cartilage destroyed by the disease process in an individual elbow joint and the development of ‘anatomical designs’ of TER with replaceable bearing surfaces for those joints in which the areas of cartilage destruction are more widespread.