Elbow Arthritis
The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.
Anatomy of the elbow
The elbow is a hinge joint allowing movements of flexion and extension. It is formed by the connection between the distal end of the humerus (made up of the capitulum and the trochlea) with the proximal end of the radius (radial head) and ulna (olecranon). These surfaces are lined with articular cartilage and lubricated with synovial fluid. This allows for a smooth, pain free range of motion of the elbow.
What is elbow arthritis?
Elbow arthritis is a degenerative condition were the articular cartilage is worn away leading to bare bone on bone contact between the distal humerus and the proximal radius and ulna. This contact between the two surfaces leads to pain and stiffness seen in elbow arthritis.
What are the common causes?
Age related changes – The so called ‘wear and tear’ of the elbow related to repetitive use over time. This slowly thins the cartilage out leading to a bare bony surface.
Inflammatory conditions – These include rheumatoid, psoriatic and other conditions that stimulate an autoimmune response leading to an inflammatory reaction within the joint that causes destructive articular cartilage and subchondral wear and painful arthritic changes.
Post traumatic – This is the sequelae of a fracture to either the distal humerus or proximal radius and ulna which can cause damage to the underlying cartilage surface leading to progressive wear and eventual joint arthritis.
Other– This includes progressive instability of the elbow due to injury to the primary stabilisers of the joint (medial and lateral collateral ligaments). Also, it can include other treatments and conditions not listed above which can affect the bone underlying the articular cartilage leading to its collapse (e.g. avascular necrosis of the capitulum). They include chemotherapy, prolonged steroid use, infections (septic arthritis), etc.
What are the preferred Investigations/Imaging?
Plain X-Ray - This should include an Anterior/Posterior and Lateral.
CT scan of the elbow- This is commonly used to asses bone stock and help identify any evidence of loose bodies, osteophytes (bony prominences) and deformity.
What are the treatment options?
Non-operative – Once a diagnosis has been obtained the first line of treatment would include non-operative measures such as analgesia, corticosteroid injections, physiotherapy and activity modification.
Elbow Arthroscopy – In some patients who are still active and who’s main complaint is stiffness, elbow arthroscopy can be helpful in clearing out the joint to improve space and enable a better range of motion. This is achieved through arthroscopic keyhole surgery.
Interpositional Arthroplasty – In patients who have complete loss of cartilage and are still young and active, Interpositional Arthroplasty is an option without having to replace the entire joint. It is an open procedure where we take graft tissue (e.g. cadaveric achilles tendon) and wrap it around the distal humerus to act as smooth cushioned surface for the proximal radius and ulna to glide on.
Total Elbow Replacement (TER) – Once non-operative measures have been exhausted and elbow arthroscopy may not be an option, TER should be considered. The best functional outcome of this treatment is achieved through early mobility following surgery and the patient understanding the restrictions of the implant.
What’s is a Total Elbow Replacement?
This procedure is performed open and involves the replacement of the distal end of the humerus and proximal end of the ulna with cobalt chrome implants that contain a polyethylene surface which allows for smooth movement within the joint. Both the humeral and ulna implants have stems which are cemented into bone providing stability. In some cases, the radial head can also be replaced, but this is not commonly needed.
What does the rehabilitation/recovery involve?
To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.