Elbow Arthritis

Georgios Panagopoulos MD | Orthopaedic Surgeon

What is elbow arthritis?

The elbow is the joint formed by the arm bone, or humerus, and the 2 bones of the forearm, or radius & ulna. It includes 3 different joints, that allow flexion, extension, pronation and supination of the forearm. Elbow arthritis is a degenerative condition that involves wear of the articular cartilage.

What causes elbow arthritis?

The causes of elbow arthritis may include:

• Osteoarthritis: this is the typical degenerative arthritis, resulting from wear related to time and continued use.
• Post-traumatic arthritis after an injury, fracture or dislocation.
• Inflammatory arthritis, in patients with rheumatological conditions, such as rheumatoid arthritis.
• Post-infective arthritis, resulting from prior infection.

What are the symptoms of elbow arthritis?

Symptoms may include:

• Intense elbow pain
• Night pain that disturbs sleep
• Elbow swelling
• Reduced range of motion
• Grinding and cracking as bones rub against each other (crepitus)

How is diagnosis made?

The patient with elbow arthritis needs evaluation by a specialized Orthopedic Surgeon. The doctor will take a history and examine your elbow carefully. An X-ray of the elbow will be needed to assess the degree of wear and tear of the articular surfaces. In some cases, an MRI or CT scan of the elbow may be needed, depending on the condition, or for preoperative planning.

Conservative treatment

Treatment is initially conservative, which may include:

• Rest
• Activity modification
• Excercise
• NSAIDS
• Physiotherapy/home exercise program
• Steroid injection in the joint

Surgical treatment - elbow arthroscopy

If conservative treatment fails, then elbow arthroscopy is a treatment option in selected patients – mainly with milder arthritis. Elbow arthroscopy takes approximately 60-90 minutes, depending on the underlying pathology and the complexity of the operation. During the arthroscopy, Mr. Panagopoulos will make 2-3 small 4mm holes in the back surface of the elbow. The surgeon inserts a small camera, the arthroscope, into the elbow. During the surgery, adhesions are released, cartilage loose bodies are removed and the degenerated joint surfaces are smoothened, in the anterior and posterior part of the elbow. Elbow arthroscopy is a demanding operation, which must be performed by a surgeon with significant experience in elbow surgery.

Surgical treatment - elbow arthroplasty

If conservative treatment fails, then elbow arthroplasty provides the definitive solution. Elbow arthroplasty is the replacement of the bone surfaces of the joint that are in contact and are usually worn. The surfaces are replaced with artificial implants, prostheses.The materials that are placed are made of metal and are completely compatible with the human body.

The 2 main types are total elbow arthroplasty and elbow hemiarthroplasty. Total elbow arthroplasty involves replacement of all the bony surfaces of the joint. The articulation between the components is artificial. A partial elbow replacement or hemiarthroplasty is when only one surface of the joint is replaced, typically the humeral side, such that the implant articulates with the opposing native bone. A hemiarthroplasty is most often performed in trauma, typically distal humerus fractures that are very distal. These fractures can be very closed to the joint line and are often not amenable to reconstruction with plates and screws. In arthritis where the whole joint is affected, a total elbow replacement is more appropriate. Most total elbow replacements are nowadays linked. This is usually a sloppy hinge, meaning that some sideways movement is still allowed by the implant. This design has been shown to have lower loosening rates. The surgeon will recommend the type of elbow replacement you need on an individualized basis.

Most people stay in hospital for 1 or 2 nights after an elbow arthroplasty. A postoperative x-ray is typically ordered prior to discharge. Early mobilization is paramount for a successful outcome. Your doctor and physiotherapist with build an individualized rehabilitation program for you. Elbow arthroplasty is technically difficult procedure with a number of potential complications and should only be performed by a trained upper limb surgeon. Dr Panagopoulos has extensive experience in complex elbow surgery and will discuss all aspects of the operation with your during your visit in the office.

The return to daily activities is gradual.Within a few days of the arthroplasty, the patient can take care of himself by doing the basic movements of his daily life.

FAQs - Frequently Asked Questions