1. Introduction

    Arthroplasty in the upper extremity makes up a low percentage of the number of joint arthroplasties performed each year. Of the two more commonly replaced upper extremity joints (the shoulder and the elbow), shoulder arthroplasty accounts for approximately 5% of the total number of joint replacements performed each year. The primary goal of shoulder arthroplasty is to relieve pain, with the secondary goal being improvement in overall joint functioning. Indications for shoulder arthroplasty include glenohumeral joint destruction as a result of osteoarthritis, complex proximal humerus fractures, rheumatoid arthritis, avascular necrosis of the humeral head, and malunion or nonunion of the proximal humerus.

    Shoulder arthroplasty is performed with the patient in either the lateral decubitus or modified Fowler (beach chair) position. Because a pneumatic tourniquet cannot be used, shoulder arthroplasty tends to result in significant intraoperative blood loss.

    Elbow arthroplasty is performed less frequently than shoulder arthroplasty. The goals for elbow arthroplasty are much the same as for shoulder arthroplasty: pain relief and improvement in joint function. The indications for elbow arthroplasty include rheumatoid arthritis, traumatic arthritis, and ankylosis of the joint.

2. Preoperative assessment