There are many options for elbow arthritis surgery. These include simple arthroscopic debridement or clearing the joint of scar tissue/excess bone that is limiting or causing painful motion, removal of the synovium, partial joint replacement, and total joint replacement of the elbow.
Overview of procedure
The technique used depends on the state of the damage in the joint. The goal is to restore function by improving motion and minimizing pain. Listed below are several options for elbow arthritis surgery:
- Arthroscopic debridement: removal of bone spurs in the joint along with loose bits of cartilage and bone (loose bodies). This procedure is best for post-traumatic or primary osteoarthritis.
- Synovectomy- arthroscopic removal of soft membrane lining the joint (the synovium) which has become damaged and inflamed due to rheumatoid arthritis.
- Elbow interpositional arthrpplasty- the goal of this procedure is to relieve pain when the bone surfaces rub together. The ends of the bone are reshaped and a small graft of soft tissue from another area of the patient’s own body is put into the joint between bones to provide a smoothly sliding cushioned surface.
- Partial or total joint replacement- this technique involves replacing the damaged joint or a piece of the damaged joint with artificial components. Two metal stems are placed into the ulna and humerus joined by a cobalt-chrome hinge pin that articulates with the joint.
Pre-treatment considerations
- Must take into account age, activity level, general health, and extent of joint destruction.
- These procedures are indicated when the patient is non-responsive to medications and non-surgical measures
- Arthroscopic debridement: Not recommended for advance rheumatoid arthritis
- Synovectomy: This technique is most used on those with early stages of rheumatoid arthritis in their elbow with little to no cartilage damage.
- Elbow interpositional arthroplasty: This is best for active people with osteoarthritis or rheumatoid arthritis with too much damage for debridement but too young for a replacement. The patient must have strong stable ligaments to hold bones in place and minimal bone loss.
- Partial or total joint replacement: The best candidates for this procedure are older less active adults with severe osteoarthritis or severe rheumatoid arthritis. It is not recommended typically for patients younger than 60 years old.
Post-treatment considerations and recovery
- Arthroscopic debridement: The recovery time is approximately 12-24 weeks including physical therapy. Patient may experience stiffness and minor pain following surgery. Elbow motion should be begun very early after the procedure is performed.
- Synovectomy: Rehabilitation from this technique will take a minimum of two months.
- Elbow interpositional arthroplasty: Recovery from this technique can take up to 4 months.
- Partial or total joint replacement: Recovery time is a minimum of 12 weeks.
Pros and benefits
- Arthroscopic debridement: This is an arthroscopic procedure so the recovery time is fairly quickly. There is typically an 80-95% pain relief and increased range of motion.
- Synovectomy: This technique improves pain symptoms dramatically, swelling decreases, and there is a faster less painful recovery because it is done arthroscopically. In addition, the surgery can be repeated if the problem comes back.
- Elbow interpositional arthroplasty: This procedure will relieve severe pain and get back some function for the patient.
- Partial or total joint replacement: Arthritis pain will be relieved and motion will be stored.
Cons, risks, and possible side effects
- Arthroscopic debridement: Bone growths tend to regrow and range or motion will decrease as a result. In addition, there is risk of nerve or blood vessel injury
- Synovectomy: The problem often comes back and surgery needs to be repeated. This surgery does not stop the disease progression of rheumatoid arthritis. The synovium will grow back and the symptoms will return. Nerve injury is a big risk of this procedure because of the tight space and close proximity to the distal nerves.
- Elbow interpositional arthroplasty: Issues with this technique include that it does not completely relieve pain or restore full function. It also cannot be performed with advance stages of arthritis.
- Partial or total joint replacement: This procedure has a high complication rate. In a span of 5-7 years typically 25% fail.
Is this technique right for you?
