Radiocapitellar Prosthetic Arthroplasty for Isolated Radiocapitellar Arthritis

Introduction

In this chapter we will discuss the evaluation and treatment of patients with isolated primary osteoarthritis of the radiocapitellar joint. Arthritis of the elbow compared with other joints is relatively uncommon. Risk factors include, but are not limited to, a genetic predisposition, manual labor, and an articular fracture. Osteoarthritis of the elbow differs from that of other joints, often with preservation of the joint space but with the formation of osteophytes or intraarticular loose bodies (see Chapters 76 and 111 ).

Cadaveric studies have shown a specific wear distribution of the articular cartilage, with cartilage thinning and loss being more prominent at the radiocapitellar joint in early stages. This is consistent with biomechanical studies showing that most of the load on the elbow passes through the radiohumeral joint.

Presentation

Patients will typically be manual laborers or have had previous trauma to the elbow. Pain during loading is the primary complaint, and most patients have a decreased range of motion usually in extension that may be relatively asymptomatic. An effusion may be palpated in the soft spot. Passive pronation and supination are typically not painful, but the “grip-and-grind” test is positive. In this test, the patient grasps the hand of the examiner and exhibits pain and crepitus with resisted pronation and supination.