Advances in implant arthroplasty in the upper extremity, circa 1988.

Artificial joint replacement has paralleled that in the lower extremity during the past 15 years. The ability to replace the shoulder, elbow, and the wrist joint has relieved pain and restored function to the upper extremities of patients with rheumatoid arthritis. Engineering developments have led to improved design, sufficient enough that the implant durability appears to exceed that of the patients' themselves. The kinematics and design of these implants has been under intensive and continuing study since the inception of these procedures. The exact anatomical restoration of the centers of motion and alignment for movement are essential for the success of these arthroplasties. We report here our long-term experience with shoulder replacement arthroplasties in which the success rate in terms of good and excellent results has been 90%. Similar results have been achieved with elbow replacement arthroplasties during a 14 year follow-up. Wrist replacement arthroplasties have also shown high good to excellent results during a nine-year follow-up period. Experience has demonstrated that if infection and wound complications are minimized, the long-term results are excellent in terms of pain relief, movement, and restoration of function.