A 65-year-old woman with long-standing rheumatoid arthritis has severe flexion deformity (50°) and ankylosis of the left elbow with inability to perform activities of daily living despite 2 years of biologic therapy. Range of motion is 70° to 50° arc. The definitive surgical treatment is:
- A Arthroscopic capsular release
- B Above-elbow amputation
- C Total elbow arthroplasty ✓
- D Ulnar nerve transposition alone
Correct answer: C. Total elbow arthroplasty
Explanation
Total elbow arthroplasty is indicated in RA for severe pain, loss of function, and failed conservative management with significant joint destruction. A fixed flexion deformity of 50° with ankylosis represents end-stage disease where arthroscopic release would be ineffective. Ulnar nerve transposition may be performed concurrently but does not address the joint destruction. Amputation is never indicated for RA elbow.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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