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Our orthopedic surgeon doesn't think our 23-year-old daughter with severe elbow deformities from rheumatoid arthritis should jump right to elbow replacements. She is recommending surgery that she calls a nonreplacement option. We are thinking about going to the Mayo Clinic for a second opinion. Do they even do this kind of surgery there?

A group of orthopedic surgeons from the Rochester, Minnesota Mayo Clinic recently published a study done on total elbow arthroplasty (TEA) in adults 40 years of age or less. They report having done elbow replacements on over 750 patients between 1982 and 2003. About eight per cent of those patients were 40 or younger. All of the 55 patients in this Mayo study had severe osteoarthritis, nonunion of bone fracture at the elbow, or severe joint instability. They either had severe inflammatory or posttraumatic arthritis. Most of the patients had at least one previous elbow surgery. Some had several (up to six) prior surgeries. They were considered good candidates for a salvage procedure such as total elbow arthroplasty (TEA). And despite 92 per cent of the group scoring good-to-excellent on the Mayo Elbow Performance Score (MEPS), there was still a 22 per cent revision rate. The surgeons consider this unacceptable and suggest pursuing non-replacement options for as long as possible. The authors concluded their report by saying the surgical treatment of elbow arthritis is very difficult. There really aren't very many good options. But before replacing the elbow, they suggest trying a synovectomy or interposition arthroplasty whenever possible. Your surgeon will explain the benefits, pros, and cons of these options. According to the experts, whichever procedure your surgeon is recommending would be worth considering first before removing the joint and replacing it with an implant that probably won't last more than 10 to 15 years. At age 23, that could mean even more surgery with the potential for further deformity and loss of function.

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