Elbow Arthritis & Stiffness / Total Elbow Replacement

My elbow always hurts and is stiff

If your elbow cause you pain and you have noticed elbow stiffness then elbow arthritis is what you might have.

What is elbow arthritis?

Osteoarthritis describes the the process of joint degeneration. Every joint consists of at least two bones with a cartilage surface at the end. The purpose of cartilage is to provide an excellent gliding surface with minimal friction. The cartilage surfaces are congruent and articulate with each other. Cartilage as a biological structure has a very limited ability to regenerate. It does not have any blood supply and receives its nutrition via the joint fluid, which is produced by the inner liner of the joint capsule (enclosure of the joint). Therefore cartilage is a one off supply biological structure and once its damaged due to trauma or wear & tear (degeneration) the osteoarthritis process commences. Four different grades are defined as:

  1. Cartilage softening
  2. Thinning and fissuring of cartilage
  3. Severe thinning and fraying of cartilage
  4. Large areas of full thickness defects in the cartilage with bone on bone contact

Who gets elbow arthritis?

Elbow arthritis is much rarer than hip or knee arthritis. It used to be more common in patients with Rheumatoid Arthritis or other inflammatory systemic arthritis forms that involve multiple joints in the body. However, since the medication for rheumatoid and other systemic arthritis types has become very efficient, elbow arthritis is not something we see very often theses days. Therefore elbow arthritis is more commonly a post traumatic appearance. In cases where a fracture has affected the cartilage surfaces the joint might develop arthritis. Also chronic elbow instability if left untreated can end up in elbow arthritis due to abnormal shear forces on the cartilage.

How is elbow arthritis diagnosed?

The clinical signs of elbow arthritis are pain, deformity and limitation of range of motion. Most often loss of extension is the first sign. X-rays, CT scan and MRI are useful to image elbow arthritis. Rheumatoid arthritis and other systemic inflammatory arthritis forms generate specific blood markers which can be investigated.

Treatment for elbow arthritis

Elbow arthritis can be treated symptomatically with painkillers and antiinflammatories. Systemic types like Rheumatoid Arthritis can be treated with specific disease modifying drugs. This is typically managed by a rheumatologist. Physiotherapy has a very limited role and when chronic incapacitating pain cannot be managed with these measures surgery becomes an option.

Surgery for elbow arthritis

Depending on the individual complaints and imaging findings, surgery can involve arthroscopy (keyhole surgery), open surgery and total elbow replacement.

Total Elbow Replacement

In cases where the elbow joint cartilage is severely worn or damaged due to systemic arthritis such as Rheumatoid Arthritis chronic pain can be managed with total elbow replacement. There are various types of devices available, some of them are hinged and in some cases hemiarthroplasty (half joint replacement) is an option.

Preparing for surgery for elbow arthritis

If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details. In select cases we will arrange for a thermoplastic custom brace to be fitted which will be used during the first few weeks after the operation.

Recovery from surgery from elbow arthritis

At the end of the procedure local anaesthetic will be injected to the surgical field and compression bandages will be placed. The arm will be placed in a thermoplastic custom brace or a shoulder immobiliser depending of the individual procedure. Exercises can be commenced roughly two to three weeks after the procedure. Dressings can be removed 10-12 days after the surgery, sutures are internally and absorbable, hence nothing needs to be removed. Full recovery with regaining range of motion and strength can be expected at the ten to twelve week mark.