Surgery of the elbow joint in rheumatoid arthritis.

A review is made of the literature of the mechanics of the elbow joint and the types of operations available. It is clear that the elbow is a complex joint and that in patients with rheumatoid arthritis destruction and disability occurs relatively late in the disease. Of the operations available, synovectomy and excision of the radial head are best done early in order to obtain the movement of supination and pronation. Total elbow replacement, particularly the unconstrained type is producing encouraging results and seems rational in view of the structure of the elbow. However it is early days in the design of these prostheses and the clear message is that the patients need full assessment in the light of their other joints involved.