Replacement Arthroplasty In The Upper Extremity

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The indications of replacement arthroplasty in the upper extremity are ever expanding. With advances in implant designs, materials and surgical techniques, clinical and functional outcomes have improved and are in some cases comparable with the commonly performed total hip and knee replacements. This has also led to increased acceptability of these procedures and such replacements are now performed very commonly in developed countries where quality of life remains a major consideration. At our Institution, joint replacement is offered for shoulder, elbow, wrist and small joints of the hand.

For the shoulder joint, the most common condition where the joint needs to be replaced includes fractures which are in multiple pieces or neglected fractures which are not amenable to plate and screw fixation. Some of the other indications include arthritis of the shoulder joint which could be secondary to rheumatoid arthritis, post-traumatic, post-infection or degeneration of the rotator cuff (These constitute the muscles that aid in lifting and stabilizing your shoulder). The shoulder could be partially or totally replaced depending on the indication. One latest advancement is reverse shoulder replacement in which there is reversal of the ball and socket mechanism of the shoulder. This is particularly useful in elderly patients with advanced rotator cuff disease.

The elbow joint is commonly involved in rheumatoid arthritis and such patients present with complaints of elbow pain, stiffness and restricted function. Total elbow replacement in such patients provides them with a painless, mobile and stable joint thereby improving their quality of life.  The operation gives movements to the stiff elbow joints. The elbow joint is also primarily replaced in patients having a shattered fracture of the lower end of humerus (the bone which forms the upper end of elbow joint). Revision of total elbow replacements done in the past which have loosened and are causing pain is also offered at this Institution.

Patients with long standing rheumatoid arthritis develop severe deformities involving the wrist and small joints of the hand. Activities of daily living are hampered in such patients leading to loss of productivity and depression. Implants are now available for replacement of these joints and have shown good long term outcomes in these patients.

-Dr. Abhinav Aggarwal

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