A 55-year-old woman who was diagnosed as RA (stage, class ) in 1995 had undergone right total elbow arthroplasty (TEA) in October 2006. We implanted her prosthesis FINE ELBOW^® (Nakashima Medical, Japan). Prosthesis of the humerus side is made of Co-Cr-Mo, and the ulna side is of polyethylene. Radius side is metal back system which inserts a polyethylene joint part in metal holder made by Co-Cr-Mo. All components were fixed by cement. She complained her right elbow uncomfortable gradually from January 2008. X-ray radiograph showed loosening of the ulnar component.

So we performed revision surgery using ulnar revision sack in May 2008. This ulnar component had only a product made in polyethylene and we inserted the component of the product made in the polyethylene in a metal sack. The operation was successed and now she does housework.

We think that strength is not worthy of the ulnar component made by polyethylene in TEA for the patient with terrible joint destruction and high daily activity patient of rheumatoid arthritis.

Surgical intervention is rarely indicated in the osteoporotic patient with compression fractures and kyphosis. In rare instances, the vertebral fracture is of the burst type, with spinal canal compromise and neurologic deficits, including paraplegia. These patients must be considered for surgical intervention. Reconstruction of such a spine poses technical challenges, because of concerns about adequacy of fixation and source of autogenous bone which is also osteoporotic. In addition, these patients frequently have serious medical conditions that increase the possibility of perioperative complications. Spinal shortening is a surgical procedure in which circumferential resection of vertebra is followed by closure of two adjacent vertebrae and fusion. It is mechanically more stable than augumentative spinal reconstruction and needs less bone graft.

Eight spinal shortenings were performed in eight patients for the treatment of paralysis due to osteoporotic vertebral collapse. Patients are ranged from 68 to 83 (average 74 years). Affected vertebrae were L1 in four, Th12 in three and Th9 in one case. After bone resection of affected vertebra from posteriorly through transpedicular route, shortening and correction of kyphosis was performed. Osteotomy was fixed by long segment instrumentation and short segment bone graft with Hartshill rectangular rod, sublaminar wiring and laminectomized local bone. Paraparesis which was present before surgery disappeared and spinal stability was obtained. Bony union was observed after six months. Surgical complication was seen in one case with hepatisis. A massive bleeding necessitating clamp of drain tube saved her life in the expense of neurological deterioration. We now consider this patient was out of indication for spinal shortening. With the follow-ups ranged from 9 to 36 months (average 19 months), neural function was preserved.

It was concluded that spinal shortening using instrumentation is a safe and effective procedure for the treatment of osteoporotic vertebral collapse with paralysis.