Elbow arthritis is common but not always symptomatic. The typical patient is in their middle age with a long career of manual work. Farming, butchering and vehicle mechanics are common groups. Inflammatory joint disease is thankfully less common these days as most patients have their disease controlled by drug therapy prescribed by their rheumatologist. Nonetheless, end stage inflammatory disease does occasionally present. The final group is post-traumatic arthritis. This is joint degeneration secondary to irregular joint surfaces left after injury. The severity of this varies greatly.
Most elbow arthritis can be managed without surgery initially. Injections to control pain and physio to maximise function are the usual starting point. Where the joint becomes very stiff, release surgery may be necessary. This can be performed either as open or arthroscopic surgery depending on the severity of the disease and degree of restriction.
The surgery involves removal of bony blocks to motion such as osteophytes (arthritis related overgrowth of bone), loose bodies and correcting or removing post traumatic deformity. In addition, soft tissue releases of the joint capsule, ligaments and local muscles (while protecting the important stabilising structures) is usually required. See our section on elbow stiffness for further details.
In cases of severe deformity or destructive inflammatory joint disease, total elbow replacement may be necessary. This involves replacing the joint with a new “hinge”. While very good for pain control and range of motion generally, this procedure confers some limitation in function. It is important that the patient does not overload an elbow replacement. The implant is able to tolerate only limited load. Overuse and excessive wear and tear can cause the implant to loosen and fail early. Moving to total elbow replacement is a big step and is not to be undertaken lightly.
At initial consultation for arthritis, a plain x-ray will help guide us. Sometimes, further imaging, typically a CT scan, is required.
Following release surgery, an extended period of rehabilitation, usually involving splints and occupational and physiotherapy is required. While good gains can be made during surgery, some of this is inevitably lost post-operatively but the range should still be better than that of the pre-operative elbow when the process is complete. One can usually expect around 30 degrees of improvement in overall arc. While this may sound small, such differences can have a huge effect on upper limb function. Improvements in forearm rotation can also be achieved but these are less predictable.
Following replacement surgery care of the soft tissues around elbow is important in the early post op phase. Sometimes a splint is required to protect the elbow for a short period but we will try to commence mobilisation early. Limitations on loading are life long.
Physios: see our therapy guidelines for post-operative care