Various surgical treatment were reported on rheumatoid shoulder. However, there were no recommended surgeries in the Japanese 2^nd basic published text of rheumatoid disease. We had performed total shoulder arthroplasty(TSA) and humeral head replacement (HHR) in patient with Rheumatoid shoulder from 1992.

The aim of this study was to compare the outcome of humeral head replacement, 2^nd generation TSA and 3^rd generation TSA in patients followed more than 5 years with rheumatoid shoulder.

Introduction

Although Total elbow arthroplasty (TEA) generally provides favorable clinical outcomes, its complications have been reported with high rate compared with other joints. Previously, we used the Bryan & Morrey approach in TEA, which included separating the triceps muscle subperiosteally from the olecranon; however, since 2008, in order to prevent skin trouble and deficiency of the triceps, we performed TEA by MISTEA method, which required no removal of the subcutaneous tissue in the region of the olecranon and no release or stripping of the triceps tendon.

Introduction

We performed humeral head replacement (HHR) with smaller head for closing the cuff defect in patients of cuff tear arthropathy (CTA). And also, if the cuff defect could not close by decreasing the head size, we add muscle tendon transfer such as latissimus dorsi transfer for posterosuperior defect and pectoralis major transfer for anterosuperior defect.

Introduction

In recently, Reverse shoulder arthroplasty (RSA) in patients with irreparable rotator cuff tear has been worldwidely performed. Many studies on RSA reported a good improvement in flexion of the sholulder, however, no improvement in external rotation (ER)and internal rotation motion (IR). Additionally, RSA has some risks to perform especially in younger patients, because high rates of complications such as deltoid stretching and loosening, infection, neurologic injury, dislocation, acromial fracture, and breakage of the prosthesis after long-term use were reported. Favard et al noted a 72% survival with a Constant-Murley score of <30 at 10 years with a marked break occurring at 8 years. Boileau et al noted caution is required, as such patients are often younger, and informed consent must obviously cover the high complication rate in this group, as well as the unknown longer-term outcome. Its use should be limited to elderly patients, arguably those aged over 70 years, with poor function and severe pain related to cuff deficiency. We developed a novel strategy in 2001, in which we used the humeral head to close the cuff defect and move the center of rotation medially and distally to increase the lever arm of the deltoid muscle.

Purpose

In total elbow arthroplasty (TEA), especially for elbows with condyle defect due to rheumatoid arthritis or trauma, determination of rotation alignment of implants is often difficult. To develop a navigation system for TEA, selecting bony landmarks that can be identified intraoperatively is important. Therefore, we developed a new roentgen free navigation system such as special alignment jigs for TEA based on CT data of normal elbows. The aim of this study was to evaluate alignments of implants after MIS-TEA using the new systems. And also, we reported that 6 bony landmarks on the elbow showed small variability in normal elbows by CT examinations and were considered to be usable as intraoperative landmarks for determining rotational position of implants last year. Especially in RA elbow, posterior aspect of humerus and ulnar aspect of proximal part of ulna were able to be identified even if there is a large bone defect that extends to the lateral or/and medial epicondyle.

We used a new roentgen free navigation system in TEA with using Solar elbow from 2009. The aim of this study was to evaluate alignments of implants after MIS-TEA using the new systems by CT examinations.