severe osteoarthritis of the elbow Fig1.1

total elbow replacement fig2.1

total elbow replacement fig2.2

What is it ?
Like any joint in the body, the elbow can undergo arthritic changes. The two main causes of arthritis to the elbow (as well as all other joints) are wear and tear arthritis (Osteoarthritis) and inflammatory arthritis (e.g Rheumatoid arthritis).
Both forms lead to damage to the articular cartilage, the grisle between the bones which a).act as a shock absorber, and b).allow the bones to run smoothly over one another. Clinical symptoms depend on the severity of the arthritis. However due to the nature of the anatomy of the elbow, range of movement can be limited early on in the process, especially being able to straighten the arm fully out. Other symptoms include pain, weakness, crunching sensation and occasionally pins and needles up and down the arm.

What can be done ?
The methods for relieving pain in any arthritic joint, whether it’s the hip, knee, spine or elbow, is always the same. This is the “therapeutic ladder”. Treatment will commence at some point on the therapeutic ladder depending on the severity of the symptoms.

1. Activity modification  – if a particular activity exacerbates the pain, then don’t do it !

2. Pain killers  – NSAID’s like Brufen can be very helpful. If you suffer from stomach upset from these, then paracetamol based pain killers are an alternative.

3. Splints  – not that helpful and practical.

4. Physiotherapy  – definitely worth trying in early arthritis if movement and strength are affected.

5. Steroid injections – Can be very helpful especially in early disease, but often not long lasting.

6. Surgery – is the only definitive treatment for persistent problems but no operation restores normal function. There are a number of operations available to your surgeon but the choice is complex.

– Open Debridement:  The bony lumps around the joint are smoothed off, loose bits of cartilage removed and the joint washed out. This is done either by an incision at the back or the side of the elbow.

– Arthroscopy:  A similar procedure can be done via keyhole surgery. This is possible if the arthritis is less severe, and if any loose bits of cartilage are relatively small.

– Synovectomy:  Applicable only to early cases of inflammatory arthritis where there is considerable swelling of the lining of the elbow joint (synovitis). It can be done as an open or athroscopic procedure.

– Arthroplasty:  This involves removal of the arthritic joint and  replacement by a metal prosthesis (replacement). This is made up of two parts held inside the two bones of the elbow by cement, and linked together by a plastic bushing. This is used in patients who have relatively low demand with respect to their day to day elbow needs. Xrays to the right show an arthritic elbow treated with a replacement.

Post-operative care
Elbow operations are either performed under general anaesthetic or with a regional block. The elbow will be dressed after surgery with either a Plaster of Paris or a supportive dressing that permits movement and light hand use.
Your stitches will usually be dissolvable. Rehabilitation, timing of your return to work and driving is variable and will depend on the type of surgery carried out. This will be discussed with you prior to the procedure.

Nerve damage.  Nerves running in the region can be bruised or damaged during the surgery and form a painful spot in the scar (neuroma) or numbness and weakness below the elbow.

Infection.  Any operation can be followed by infection and this would be treated with antibiotics. Infection around a joint replacement is a serious complication and will require further surgery. The risk is very low.

Scar.  You will have a scar on the elbow. This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with the moisturizing cream.

Function.  Your function will recover slowly and it will probably be six months before you will reach your final result.

Stiffness.   Elbows can stiffen after any form of surgery. Flexion (bending) usually returns fairly well, but extension (straightening) can take a lot longer

Loosening.   Elbow replacements can work loose with time. It is for this reason that they are used only in specific patients.