ABSTRACT
End stage joint failure, i.e. destruction of the articular surface can result from inflammatory and non-inflammatory disease. Whilst medical treatment might delay the onset of joint failure, surgical treatment should be regarded as part of the process of management of disease, rather than failure of medical therapy. Indeed some surgeons, particularly those concentrating on upper limb disease, feel that results could be better if joints are surgically treated before they are completely destroyed. In end-stage joint disease, the joints are no longer able to function, and the symptoms are primarily mechanical rather than inflammatory with pain, loss of function, instability and deformity, being major symptoms. Crepitus is often found at this stage, resulting from bone on bone articulation in the absence of cartilage. Surgical options are two-fold, either arthrodesis (fusion) or arthroplasty generally total joint replacement. Indications for total joint replacement are the same for osteoarthritis (85% of cases) and rheumatoid arthritis (15% of cases). In general proximal joint surgery is undertaken before distal as this maximises functional improvement in the upper limb, and limits the potential element of referred pain to the knee or elbow.
