Arthoplasty (joint replacement) in the extremities has been practised for the past 150 to 200 years. From 1781 to 1885 subperiosteal subcapsular excision was done in tuberculous elbow joints. Still now no single arthoplasty has been developed that satisfies all the requirements of every disabled elbow joint.

The history of elbow joint replacement can be divided into four time periods. First period (1885-1947), second period (1947-1970), third period (19701975) and fourth period (1975-present). Metallic prosthesis introduced in second period. Recent advancement in high quality metal and poly methy-methacrylate and polyethene.

Entirely elbow joint replacement was done at first in 1860 by

Verneil and in 1885 by Ollier. It involves removal of the entire elbow joint by resection of the distal humerus and proximal radius and ulna. It was used for the treatment of elbow ankylosis following tuberculosis. Resection arthroplasty is now used as a salvage procedure usually fol- lowing infection or the to treat a failed irretrievable arthroplasty procedure. A variety of substances have been used as interposition materials for both resection and anatomic arthroplasty of the elbow which improve movement of elbow joint and reduces the chance of ankylosis.

In Europe, arthroplasty was popularized by Payr and Putti, who performed biologic materials or living membranes to cover bone ends.

Replacement arthroplasty of elbow joint is done when functions of the joint are grossly lost. Maybe traumatic, congenital, maldevelopmental, septic arthritis, tuberculosis, rheumatoid arthritis and neoplastic. When elbow is ankylosed or painful and no other surgery can help in that case total elbow joint replacement is very helpful. Proper

selection of patient prosthesis, operation theater and post operative care facilitates the final outcome of the result.

The picture of our country Total elbow joint replacement or arthroplasty especially metallic prosthesis is not very commonly done in our country. Actually we are very much over burdened with traumatic cases. Day by day trauma becoming like infectious diseases. This is why sophisticated surgery like prosthesis replacement is sometimes luxurious for us. But it is only understood by the sufferer that it is a basic demand. Anyway replacement of hip and knee joints are very commonly done all over the world. Hip joint replacement have been started in our country few years back. Knee joint replacement has not been done in any government hospitals.

Privately few operations of total knee joint replacement have been done at BIRDEM and in a privae clinic. Elbow joint replacement was not done in any hospital except one operation is done by me a year back in a private clinic. So far my memory goes one operation was done at BIRDEM. In government level like in Medical college hospital this is the first time we have successfully replaced a metallic hinged elbow prosthesis in 18 years old man at Sir Salimullah Medical College and Mitford Hospital.

About 10-15 thousand people have been suffering from ankylosed elbow or very painful functionless elbow joint who needs proper treatment like total elbow joint replacement.

This type of operations are going on very commonly in developed countries. In India, Bangkok and Singapore very sophisti-

cated prosthesis are available. But they are very costly. In developing country like Bangladesh very often we cannot effort them very easily. But technology is not so hard for this type of operative procedures. We have skilled manpower in respective sector. We just need our good will and attitude to deal with them.

Comparatively in trauma management our orthopaedic surgeons have wide response. They are doing very noble works and deserves appreciation. If government or NGOs extend their active co-operation in this sector, we can give new life to lot of helpless poor people with minimum expense. In that case we need not go abroad for the treatment of this sort of disability.