A 62-year-old woman with 20 years of rheumatoid arthritis has a painful, grossly unstable right elbow with crepitus, absent elbow motion arc beyond 30 degrees, and radiographs showing complete erosion of the trochlea and capitellum with loss of the distal humeral and olecranon articular surfaces. Conservative measures have failed. The most appropriate operation is:

• A Synovectomy with radial head excision
• B Elbow arthrodesis at 90 degrees
• C Arthroscopic debridement and capsular release
• D Linked (semiconstrained) total elbow arthroplasty ✓

Explanation

End-stage rheumatoid elbow with destroyed articular surfaces, severe pain, and instability needs a linked total elbow arthroplasty, because ligamentous insufficiency demands the implant itself provide constraint. Synovectomy with radial head excision is reserved for earlier disease with preserved cartilage and stable joints, so it cannot fix bone loss plus instability. Debridement suits mild disease. Arthrodesis is essentially never performed at the elbow because fusion sacrifices forearm positioning and is poorly tolerated.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.