Without the opportunity of combining shoulder movements with elbow function, the need for corrective surgery would be far more common. Various operations have been described in the use of elbow arthropathy associated with haemophilia. These operations include synovectomy, simple excision of the radial head combined with joint debridement, excision arthroplasty, arthrodesis and silastic interposition arthroplasty [1,8–11]. Excision of the radial head combined with synovectomy has resulted in consistently good results with reduction in pain, an increased range of forearm rotation (but not necessarily flexion/extension)

and a reduction in the frequency of joint bleeds. Ulna nerve neurolyses have been carried out either by incision of the fibrous attachments around the ulna canal or by anterior transposition of the nerve. In advanced cases, however, replacement arthroplasty Y-27632 in vivo APO866 in vivo may become indicated if there is significant destruction of the joint. The

actual incidence of joint replacement, however, is likely to be low given that Bajekal reported that 81% of haemophiliacs suffered recurrent elbow bleeds but reported a low incidence of total joint replacement in the same group[12]. Although total joint replacement has been well described for the hip, knee and shoulder in haemophilia, there have been few reports concerning total elbow replacement. Most reports have been restricted to isolated case reports [10,13–15]. The first report by Luck and Kasper [10] reviewed the 20-year results of a total of 168 surgical procedures carried out for haemophilic arthropathy but included only two total elbow replacements, one of which medchemexpress became infected. Kasten and Skinner [16] in their large series of total elbow replacement described only two cases of haemophilia, one primary and a further revision. The largest published series to date comes from the Oxford group and concerned seven elbow replacements in five patients with severe haemophilia A [17]. All patients demonstrated

excellent relief of pain and improvement of function. There was one failure due to infection in an immunocompromised patient with HIV and hepatitis C. The patients were followed for a minimum of 25 months and implants varied from unconstrained (Kudo or Souter-Strathclyde) to the more constrained Coonrad-Morrey joint replacements. There were three major postoperative complications, one ulnar nerve palsy, one axillary vein thrombosis and one patient who developed late infection requiring excision arthroplasty. They felt that the results were excellent in the short to medium term and they concluded that total elbow replacement is both feasible and useful in patients with severe haemophilic arthropathy. Kaminemi [18]from the Mayo Clinic reported their results in five patients who had total elbow replacement. The mean age was 39 years with a mean follow-up of 5.8 years. Two patients died of AIDS and another from chronic renal failure.