Arthroplasty of the shoulder and elbow

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Although the primary indication for arthroplasty of the shoulder and elbow continues to be disabling pain secondary to various arthritic conditions, the indications are expanding. Proximal humeral hemiarthroplasty is now the treatment of choice for patients with massive rotator cuff defects and glenohumeral arthritis, also referred to as cuff tear arthropathy. For optimal long-term results, the design of a total shoulder prosthesis should closely approximate normal shoulder anatomy. Meticulous operative techniques can minimize potential complications of total shoulder arthroplasty such as fracture, instability, and neurovascular injury, whereas appropriate postoperative rehabilitation can maximize the clinical result. Both semiconstrained and nonconstrained total elbow arthroplasty prostheses continue to provide relief of pain and improved function for patients with rheumatoid arthritis. Prosthetic loosening and infection are frequent causes for revision surgery, but the incidence of these complications remains low. Careful handling of the soft tissues and meticulous operative technique with preservation of the supporting soft tissue structure can help minimize potential complications of total elbow arthroplasty such as ulnar nerve dysfunction, infection, and instability.

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