Surgical treatment of the rheumatoid elbow.

In rheumatoid arthritis, the elbow is involved in 20 to 50% of the cases. Surgical treatment for rheumatoid arthritis is proposed to patients in whom an appropriate and adequate attempt at medical management has failed. Improvements in surgical technique and prosthetic design have led to more predictable results in the surgical treatment of the rheumatoid elbow. Surgical treatment of the patient with rheumatoid arthritis continues to evolve. Synovectomy continues to be an effective palliative procedure, preferred in the early stages of disease (I, II, IIIA) with or without radial head resection. Further investigation into the use of arthroscopic techniques may result in decreased morbidity and a quicker recovery. In more advanced stages (IIIA, IIIB, IV), total elbow replacements by experienced surgeons employing contemporary designs, unconstrained or semiconstrained, and surgical techniques are associated with a high degree of success with long-term follow-up, approaching that fortotal hip and knee replacement. Finally, interposition arthroplasty can be proposed for young adults with stage II or IIIA rheumatoid arthritis in whom the elbow is mainly stiff and painful.