Over a ten-year period,
arthroplasty of the ipsilateral shoulder and elbow was performed in thirty-five extremities of thirty-one patients who had advanced
rheumatoid arthritis. The results of the procedures were retrospectively reviewed to determine the appropriate sequence of surgery and the functional results that were obtained. All patients were followed for a minimum of two years after the last
arthroplasty. The elbow had been operated on first in twenty-one extremities and the shoulder had been operated on first in fourteen. The time-interval between
arthroplasties was significantly longer (p less than 0.005) when the elbow had been operated on first (forty-five compared with 13.4 months). All motion of the elbow and elevation and external rotation of the shoulder improved significantly (p less than 0.005), similar to the improvement in motion that is noted when either joint is operated on alone. Also, there was a highly significant reduction in
pain and improvement in function (both, p less than 0.001). Review of the roentgenograms of twenty-three patients demonstrated no
humeral fractures or interference in the proper placement of the humeral component of the
prosthesis either by the stem of the other
prosthesis or by the
methylmethacrylate. All of the
arthroplasties of the shoulder that were performed as the second
arthroplasty were done at least five months after the
arthroplasty of the elbow, and no dislocations or subluxations of the components of the
elbow prosthesis occurred.(ABSTRACT TRUNCATED AT 250 WORDS)