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Total elbow arthroplasty: a clinical review of 30 cases employing the Mayo and AHSC prostheses.

Chronic synovitis of the elbow in rheumatoid arthritics that has not responded to four to six months of optimal nonoperative management should be treated by synovectomy even in the absence of significant intra-articular X-ray changes. When intra-articular damage is significant, an arthroplasty will not only relieve the pain, but may also provide a satisfactory range of motion. It is necessary to consider all the possible complications and the fact that technically, total elbow arthroplasty is a difficult operation to perform. Because of the potential for loosening, one might consider using an unconstrained device in the patient with adequate bone structure, reserving the semiconstrained devices for elbows with disintegrated bone tissues. The constrained prostheses should be used only for the most severely disorganized and unstable elbows.