Arthritis refers to loss of the smooth surface (articular cartilage) of the joint. This can occur from general wear and tear (osteoarthritis) but can also happen after inflammatory conditions (such as rheumatoid arthritis) or after an injury or trauma (post traumatic arthritis).
The patient presents with pain and/or stiffness in the elbow. There may also be episodes of ‘locking’ where the elbow may become stuck in certain position but can be released with trick movement. The pain is usually generalised around the whole of the elbow. It is usually worse with loading of the elbow and there is often night pain.
How is the diagnosis made?
The diagnosis is based on history and examination. Examination will show the restriction in movement. There may be clicking (crepitus) on movement. X-rays will be satisfactory to confirm the diagnosis.
What is the treatment?
All patients are treated conservatively first with activity modification and analgesia as required. Physiotherapy is aimed to maintain the range of movement and strength in the elbow.
If pain persists, steroid injection can be considered but often these have no effect or temporary relief.
Surgically, there are options. If the arthritis affects the outer part of the elbow (radiocapitellar joint) then an excision of the radial head (saucer shaped forearm bone at the elbow) can be done. This is a day case procedure and requires general anaesthetic.
If the arthritis is in its early stages, debridement (tidy up) of the joint is an option. This includes washout, release of ligaments and removal of loose parts in the joint. This may also involve removal of part of the bone in the elbow. This operation can be keyhole (arthroscopically) or open. This is also performed as a day case procedure and requires general anaesthetic.
In very advanced arthritis, the only option may have to be replacement of the elbow with artificial joint. This can be for only part of the elbow (such as radial head replacement) or for the whole elbow (total elbow replacement). This often requires a stay in hospital for 1-2 nights.
After all these procedures, patients will have dressing and bandages, but will be allowed to move the elbow. The stiches are taken out at 2 weeks. The patients will be advised of the rehabilitation process by their treating surgeon. However, it will take a couple of months to achieve best results.
Risks of Surgery
The risks include infection, bleeding, nerve injury, instability, persistent pain and stiffness, loosening of the metal works, fractures, need for further surgery. With total elbow replacement, there will be restrictions on who much a patient can carry or use the elbow. These are best discussed in details with your treating surgeon.