The rheumatoid elbow

Abstract

The orthopaedic management of the rheumatoid elbow continues to be a challenging and difficult problem. Although the medical management of rheumatoid arthritis continues to improve, the surgical alternatives of synovectomy, capsular release, radial head excision, and total elbow arthroplasty each have their own very important place in the successful comprehensive management of the rheumatoid elbow. As arthroscopic management of orthopaedic conditions in general continues to evolve and improve, so do the results of arthroscopic management of the recalcitrant symptomatic rheumatoid elbow. Total elbow arthroplasty continues to represent an exceptionally successful alternative for the treatment of the severely affected rheumatoid elbow. Linked, semiconstrained and unlinked resurfacing elbow arthroplasties are available, and each has their proponents. Based on the current orthopaedic literature available, the linked, semiconstrained implants overall have a slightly less complication rate, higher patient satisfaction, and greater survivorship than the resurfacing designs. However, a well‐performed prospective, randomized, blinded trial comparing these two types of implants has not yet been performed. The orthopaedic surgical management of the painful rheumatoid elbow continues to evolve. Arthroscopic synovectomy and capsular release without a requisite radial head excision has great clinical advantages and may likely soon represent the procedure of choice over the more traditional open approach. Total elbow arthroplasty using a linked, semiconstrained implant currently represents the most effective arthroplasty alternative considering complication rate, clinical success rate, and implant survivorship. Continued basic science and clinical research efforts are ongoing in the areas of total elbow arthroplasty design.