EXCISION OF THE HEAD OF THE RADIUS IN RHEUMATOID ARTHRITIS

The results of excision of the head of the radius in forty-four elbows affected by rheumatoid arthritis are presented. Relief of pain was obtained in 90 per cent and an increase in the range of flexion and extension was seen in 70 per cent. Involvement of the humero-ulnar joint seen radiologically is no contra-indication to the operation; simple excision of the radial head often gives gratifying results. In our experience the relief of pain and increased range of movement have greatly reduced the need for total replacement arthroplasty. Involvement of the elbow in rheumatoid arthritis may start early in the history of the disease, but surgical treatment is often not considered until a late stage-often not until marked destructive articular changes have occurred. The reasons for this delay are obscure. It may be that early symptoms are slight or that they are overshadowed by those from other major joints. Lame and Vainio (1969), presenting the results of synovectomy, commented: “Too many patients had a long-standing disease which was no longer suitable for synovectomy”. Excision of the head of the radius in rheumatoid arthritis was advocated by Smith-Petersen, Aufranc and Larson (1943) ; they reported satisfactory results in fifteen cases. Good results were also reported by Torgerson an