Upper Limb Joint Replacement History, Performance and Criteria Flashcards
What are the two main goals of upper limb joint replacement?
eliminate pain
restore function to the replaced joint to restore hand functions
When was the first shoulder replacement performed?
1893
Who pioneered the first successful shoulder replacements?
Charles Neer
Who performed the first elbow replacement and when?
Robineau - 1925
Who attempted and when, the first total wrist replacement?
Gschwend & Lalive 1969
What conditions can lead someone to need an upper limb joint replacement?
OA RA osteonecrosis post-traumatic arthritis fractures
Why is it necessary to develop an individual treatment plan for RA sufferers?
they have multiple joints affected
Describe the common order of treatment in an RA sufferer with multiple joints affected
Spine/ lower limb problems will be treated beforehand
rheumatoid arthritis of the cervical spine may cause instability and can be associated with significant or progressive neurological symptoms, which must be addressed in order to prevent permanent damage to the spinal nerves or cord;
successful total joint replacement of the hip and knee will lessen or eliminate the need for the upper limb to support the body weight during walking (by means of crutches, etc.) or during other activities (such as stair climbing, standing up). If these loads are not reduced or eliminated they could potentially compromise the success of an upper limb joint replacement.
Which joints are commonly given priority when several upper limb joints are affected?
distal to proximal
Why are joints replaced distally to proximally when there are multiple affected joints in the upper limb?
the primary objective is to restore function of the hand
impairments in distal joints may compromise the critical, early physio necessary following a more proximal joint replacement
(arguably more functional improvement is gained the more distal the joint)
Why do some surgeons of prefer to replace proximal joints first?
shoulder pain is more troublesome at night and may radiate to the elbow
immobile shoulders cause increased elbow loading which may lead to early failure
rehab of other joints can be simplified with a pain-free/nearly pain-free shoulder
What materials are used in upper limb joint replacements?
stainless steel cobalt chrome titanium + alloys vitallium alloy HDP PMMA cement
How have upper limb joint replacements functioned in the category:
Relieve pain and enable the patient to achieve sufficient mobility to be able to manage daily living activities.
pain can be eliminated or at the very least reduced to a tolerable level
better pain relief and ROM can be achieved in total as opposed to hemiarthroplasty
How have upper limb joint replacements functioned in the category:
Function without failure; ideally it should last the expected life span of the individual patient.
survival rates have not reached those found in hip/knee but have a lower frequency of use
shoulder > elbow > wrist + finger
How have upper limb joint replacements functioned in the category:
Be designed for insertion such that a predictable outcome can be reasonably guaranteed by a competent surgeon.
small dimensions and limb complexity means replacement surgery is demanding.
it is unlikely that a general orthopaedic surgeon however competent will have the required experience. In most centres one or two surgeons will specialise in this surgery.
