Arthritic elbows are typically painful, stiff and swollen. Sometimes the destruction of the bearing surfaces and supporting structures is so severe that the joint becomes very deformed or even fused. To start with, most people suffer pain related to moving and loading the elbow, but eventually the pain becomes constant as the joint surfaces continue to deteriorate. Loose bodies floating inside the joint can sometimes cause the elbow to ‘lock’ in a certain position.
Yes. Rheumatoid arthritis and other inflammatory joint conditions used to represent the majority of patients with elbow arthritis requiring surgery. Thankfully, modern anti-rheumatoid drugs have significantly reduced the progression of joint destruction for most patients with rheumatoid arthritis.
Primary osteoarthritis; the most common form of arthritis in other joints and sometimes called ‘wear and tear’; now represents an increasing proportion of cases. Another cause of arthritis is joint injury, such as dislocations and fractures around the elbow. If these don’t heal well, or if the injury has affected the joint surface, then the risk is higher still.
No. The elbow involves three joints. The main hinge is between the ulna and the humerus. The second joint is between the radial head and the humerus (capitellum) and is responsible for forearm rotation. There is a third, small joint between the two forearm bones at the top of your forearm. Elbow arthritis can affect just the radio-capitellar joint, or the whole joint can be affected.
Whilst small focal injuries to the cartilage of the elbow can sometimes heal, or be improved with surgery, once arthritis of the joint has set in there is currently no way to reverse the damage. However, the pace of deterioration and the pain patients experience varies significantly, so it is not a foregone conclusion that all patients with elbow arthritis will require surgery.
In the early stages, simple things like anti-inflammatory gels and tablets, Paracetamol, heat packs and gentle exercises can improve symptoms. Many patients with arthritic joints experience a waxing and waning pattern of symptoms, with a slow deterioration of the baseline symptom level. Once the pain begins to interfere significantly with your daily life, you may well seek a specialist opinion.
If your pain becomes more severe you may opt for a cortisone injection. You are likely to notice more pain for a few days after the injection, but the cortisone will start to kick in at about a week. The beneficial effect of this cortisone is variable, but most patients will enjoy three months or more of significant benefit. The risks of injury or infection from the injection are very low. Physiotherapy and splinting may also have a role in some patients where stiffness is an issue.
The aims of these surgeries are to improve your range of motion and pain by releasing tight soft tissues, resecting bony spurs and clearing loose bodies and debris from within the joint. Arthroscopic (keyhole) arthrolysis surgery can improve your range of motion by approximately 20 degrees. In open surgery, the same processes occur, but the open operation is a little more invasive. However, it typically achieves slightly more improvement in your range of motion (Approximately 30 degree improvement). You may be asked to stay in for a day or two with your arm in a continuous motion machine – this is designed to preserve the motion gains achieved in your surgery. The choice of which operative approach is best depends on your type of arthritis, your range of motion deficit and your imaging - your surgeon will recommend which type of operation will work best for your elbow.
If your arthritis is confined or predominantly affecting your radio-capitellar joint (pain over the outside made worse on forearm rotation) then you may benefit from removal of your radial head. This decompresses your arthritic joint and prevents the worn out surfaces from rubbing against each other. This operation is normally achieved via a small open incision over the outer aspect of your elbow, but it is sometimes performed ‘keyhole’.
Unfortunately, for some patients, the damage is just too advanced for the elbow to be salvaged and a replacement is then indicated. In an elbow replacement your worn out surfaces are replaced by a loose-hinge metal and plastic bearing with stems and bone cement used to fix those bearings in place. The operation requires a long incision over the back of your elbow and often includes excision or replacement of your radial head at the same time.
After your operation, you will be in a plaster for a week or so to allow your wound to heal. Thereafter you will begin your rehabilitation programme to restore your range of motion. You will have a sling for comfort for a few weeks.
Elbow replacement is a complex operation with a risk of complications - your surgeon will explain these risks to you. These include: infection; nerve injury; instability; loosening and wear of the replacement. All joint replacements wear out eventually, but modern materials and implant designs produce survival rates of elbow replacement of around 90% at ten years. A replaced elbow is however never as strong as your original elbow. You will therefore be advised to avoid heavy lifting forever with your replaced elbow. If you do use your elbow in an excessively robust manner, the risk of early wear and loosening is higher.
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I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
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