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Arthritis is a condition that can affect different joints of the body, including the elbow. This article outlines the four major types of elbow surgeries that patients with arthritis of the elbow can undergo.

Arthritis is an inflammatory condition that can affect many joints in the body, including those of the hips, knees, ankles and elbows. While there is no cure for arthritis, several treatment options are available to patients — including medication, physical therapy and, in extreme cases, surgery. Orthopedic surgeons perform a range of surgeries for arthritis patients. The choice of surgery generally depends on the type of joint involved in the disease. 

While all surgeries are challenging to some extent, elbow surgery can be particularly tricky, as the elbow is a small and complex joint. These are the four surgeries that are available for patients who have arthritis of the elbow.

1. Synovectomy

The synovium is a soft membrane that lines all joints, including the elbow joint. The synovium produces a fluid known as synovial fluid that lubricates all joints and diminishes friction between the bones as they move. In patients with different types of inflammatory arthritis, including rheumatoid arthritis, the synovium becomes inflamed and eventually erodes the cartilage (a soft cushioning that lines the joints), leading to pain and swelling. A synovectomy is a type of surgery that is performed to remove the synovium, which stops the process of cartilage erosion.

The ideal candidate for a synovectomy is a patient in the early stages of their disease and who therefore has little or no damage to the cartilage. The advantages of undergoing a synovectomy are that it significantly helps improve symptoms, performance, swelling and pain. Furthermore, a synovectomy leads to a faster and less painful recovery. The disadvantage associated with undergoing a synovectomy is that it doesn’t stop disease progression. In fact, after many years, the synovium will regrow and the symptoms come back. Fortunately, the surgery can be repeated. Another disadvantage to this procedure is that a patient can experience nerve injury.

2. Arthroscopic debridement

Patients with arthritis will often have bone spurs or bony growth in the joint that is affected. Arthroscopic debridement is a type of surgery in which the doctor will remove these bony growths as well as loose parts of the bone or cartilage. The recovery time for this surgery ranges between 12 and 24 weeks, but depends on how the surgery was done and the age of the patient.

The ideal candidate for this surgery is one who has mild to moderate osteoarthritis (a common type of arthritis), and has minor pain and stiffness. Patients who have extreme pain or advanced disease are generally not good candidates for this type of surgery. The advantage of this type of surgery is that it provides significant pain relief. In fact, most people experience pain relief and improved range of motion. The disadvantage of this surgery is that the bony growths tend to re-develop. Therefore, the range of motion is reduced over time. However, despite the recurrence of bony growths, people still continue to experience pain relief.

3. Elbow interpositional arthroplasty

This is a type of surgery that is performed in order to relieve the pain that patients experience when their bones rub together. An elbow interpositional arthroplasty involves reshaping the ends of the bone. A small section of soft tissue is then fitted into the space between the joints to reduce the friction that occurs when bones rub. Recovery time for an elbow interpositional arthroplasty can be up to four months.

The ideal candidates for this type of surgery are patients with osteoarthritis or inflammatory arthritis who have too much joint damage to undergo a debridement but are too young to undergo a joint replacement surgery. The advantage to undergoing an elbow interpositional arthroplasty is that it can relieve severe pain while helping retain function of the elbow. Additionally, this surgery allows bone stock to be preserved, which is important if an elbow replacement is needed in the future. The disadvantage of this surgery is that it doesn’t completely eliminate pain, nor does it restore the full function of the joint. Furthermore, it cannot be done in patients who have severe arthritis.

4. Total elbow arthroplasty or replacement

A total elbow arthroplasty replacemes the damaged parts of the elbow with artificial implants. The average recovery time is at least 12 weeks. The ideal candidates for this type of surgery are patients who are older and less active and who have end-stage inflammatory arthritis. Increasingly, patients with osteoarthritis are also getting elbow replacements. However, this type of surgery is not recommended for patients below the age of 60, as implants don’t normally last longer than a few years.

The advantage of a total elbow arthroplasty or replacement is that can help relieve pain and restore motion and function of the elbow in patients who have severe damage and deformation of their joints. The disadvantage is that complications are more likely to strike in cases of elbow replacement than replacement surgery for other joints. In general, elbow replacements have a high failure rate, with 25 percent of implants failing at five to seven years post-surgery. Additionally, when the implants fail there is a lack of other options for patients.

Conclusion

If you are considering undergoing surgery for treatment of elbow arthritis, it is best to sit down with your surgeon and carefully discuss the pros and cons of each procedure.

  • Savoie III, Felix H., Pierce D. Nunley, and Larry D. Field. "Arthroscopic management of the arthritic elbow: indications, technique, and results." Journal of Shoulder and Elbow Surgery 8.3 (1999): 214-219.
  • Ogilvie-Harris, D. J., R. Gordon, and M. MacKay. "Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow." Arthroscopy: The Journal of Arthroscopic & Related Surgery 11.4 (1995): 437-443.
  • Little, Christopher P., et al. "Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative study of three implants." JBJS 87.11 (2005): 2439-2448.
  • Photo courtesy of SteadyHealth

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