What is this?
Elbow arthritis is wearing of the elbow joint that can cause pain and stiffness. The two main forms are osteoarthritis and rheumatoid arthritis. Osteoarthritis (degenerative wear) is characterised by the formation of bone spurs in the elbow joint in addition to thinning of the cartilage lining. Typically there is no obvious cause although heavy manual work or a previous injury may predispose to this condition. In rheumatoid arthritis the patients’ own immune system mistakenly attacks the joints causing inflammation and damage.
What are the symptoms?
Pain, stiffness and swelling are the main symptoms of arthritis of any joint. At first, the pain is related to activity. As the condition worsens, you may feel pain even when resting, which may interfere with sleep. Gradual loss of elbow motion leads to decreased function, which may have an impact on activities of daily living.
Will I need any further investigations?
X-rays are required to look for wear of the joint space and for the presence of bone spurs (osteophytes). CT scans give a 3-D view and allow for a more detailed assessment of the size and location of bone spurs. This information is very useful when planning surgery to remove the spurs.
What are the non-surgical treatment options?
Initially, pain medication and anti-inflammatory drugs (such as ibuprofen) may be helpful to help control swelling and pain. It is sensible to modify or limit your activities with the arm to reduce the load on the elbow. Cortisone injections into the elbow joint may provide some temporary relief.
What does surgery involve?
There are a number of different surgical options that depend upon the severity of the condition and your level of function.
Arthroscopic debridement
This involves keyhole (arthroscopic) surgery to see inside the elbow joint, remove bone spurs / loose fragments and release the scarred lining of the elbow joint.
Open debridement
If the arthritis is much more advanced, there is severe loss of elbow motion or the bone spurs are very large, then it may be more appropriate to perform an open procedure.
Elbow joint replacement
Elbow replacement is a last resort and is reserved for a very small group of patients. These include patients with severe rheumatoid arthritis and less commonly osteoarthritis. The worn joint surfaces are removed and artificial components are inserted. Due to risks of wear and loosening of the prosthetic joint, patients must be willing to accept low levels of activity involving the elbow.
What is the success of surgery?
More than 80% patients will achieve a better range of movement and significant improvement in their pain after debridement of the elbow. The surgery however does not remove the arthritis process and therefore it is possible that with time the symptoms may return. Elbow replacement is typically very effective in providing a pain free elbow with a good functional range of movement.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The commonest risks of surgery include infection, bleeding, and failure to fully cure the problem. The close proximity of several nerves that cross the elbow make nerve damage an additional particular concern with surgery on the elbow joint. The risks with an elbow replacement relate the artificial nature of the joint; in particular, wear and loosening of the components that may require redo surgery in the future.
What is the recovery after surgery?
Recovery very much depends on what surgery is performed. You will see a physiotherapist prior to discharge and as an outpatient to show you exercises and guide your recovery. The use of an ice pack on the elbow may also be helpful for the first few days after surgery. You will be seen in clinic around two weeks after surgery to check the wounds, remove sutures (if necessary) and assess recovery.
Arthroscopy
The advantage of arthroscopy is that no muscles have to be detached to carry out the surgery and therefore restrictions are minimal afterwards. You can begin moving the elbow with light activity from day one of the surgery. It is important to keep the elbow moving to prevent it re-stiffening.
Open debridement
Swelling and bruising after open debridement is usually greater than after arthroscopy because it is more invasive. However it is important to keep the elbow moving as much as possible to prevent stiffness.
Elbow joint replacement
After surgery the elbow is immobilised in a wool bandage for 48hrs to allow the tissues to settle. This is removed at this point and gentle motion is commenced. Following the wound healing a full range of motion can be performed but it is important to avoid straightening the elbow against resistance (such as pushing out from a chair) for the initial 6 weeks after surgery whilst the repaired tissues are healing.
When can I return to normal activities?
Return to work depends on the nature of the job. You can return to desk and computer work when you feel comfortable to do so but avoid any manual work, heavy lifting or sporting activities for 4-6 weeks. You may return to driving when you feel safe to control the vehicle, which is usually about 10-14 days after surgery for a debridement procedure or approximately 6 weeks for an elbow replacement. Restrictions are greater following elbow replacement and generally speaking any heavy activity with the elbow should be avoided permanently. The maximum weight carried in the side with an elbow replacement should be no more than a bag of sugar.
