Total elbow replacement in the treatment of rheumatoid disease

Improvements in total elbow arthroplasty during the last 20 years have resulted in clinical outcomes which now are comparable with the results of hip arthroplasty. The main types of prostheses used are unlinked prostheses or semiconstrained hinged prostheses. The unlinked prostheses require the preservation of bone stock and the ability to reconstruct the collateral ligaments to achieve stability. Semiconstrained, hinged prostheses have inherent stability but humeral loosening was initially a problem. Stress transfer through the humeral stem can be reduced by using a prostheses with anterior flanges (Coonrad-Morrey or GSB3). Survivorship analyses beyond 10 years now are becoming available for these prostheses. There has been no universal agreement as to which outcome measure should be used for total elbow replacements. Future developments will include an evolution of principles as understanding of elbow biomechanics progresses. Operative technique is likely to be modified by the development of alignment aids and jigs.