General criteria for upper limb joint replacements

Question 1

What is the aim of upper limb joint replacement?

Answer 1

Primarily to eliminate pain

Secondly to restore function with a view to restorying the overall functions of the hand

Question 2

What conditions tend to lead to the need for upper limb joint replacement?

Answer 2

Rheumatoid arthritis
Osteoarthritis 
Osteonecrosis 
Post-traumatic arthritis 
Fractures

Question 3

Why in patients with multiple joint involvement are lower limbs and spines prioritised over upper limb replacement?

Answer 3

RA of the cervical spine can cause instability and neuro issues

Successful lower limb will lesssen the need for upper limb to support body

Question 4

If all upper limb joints are equally painful what is the usual prder of replacement?

Answer 4

Distally to proximally (i.e. fingers first)

Question 5

Why are upper limb replacements performed distally to proximally?

Answer 5

Primary objective after ain relief is to restoe hand function
Impairments in distal joint may compromise early physio of proximal joints
Arguable that more functional improvement is gained the more distal the joint

Question 6

Why do some surgeons prefer to replace the shoulder first?

Answer 6

Shoulder pain is more troublesome and may radiate to the elbow
An immobile shoulder will cause abnormal loadings at the elbow (could cause failure of elbow prosthesis)
Rehab of other joints can be simplified by a pain free shoulder

Question 7

Which upper limb replacement has been found to be most successful in survival terms?

Answer 7

Shoulder (followed by elbow)