Eventually, it may be necessary to consider some type of surgical treatment. There are several operations to treat advanced osteoarthritis of the elbow. Your surgeon will consider many factors when deciding which procedure is best for you, including the severity of joint degeneration, your age, your activity level, and how you use your elbow.
If you are in an early stage of osteoarthritis, your doctor may recommend arthroscopic debridement. Other names for this procedure include arthroscopic ulnohumeral arthroplasty or osteocapsular arthroplasty.
Arthroscopic procedures use an arthroscope, a tiny TV camera that is inserted into the joint through a very small incision. The arthroscope allows the surgeon to see inside the elbow joint.
In arthroscopic debridement, the surgeon makes other small incisions for inserting special tools to get rid of bone spurs, remove loose bodies, or smooth the cartilage. Sometimes a capsular release is needed. The capsule is a fibrous covering around the joint. An incision is made in the tissue and the anterior (front) of the capsule is removed.
Your surgeon may also do lavage in the joint. Lavage involves rinsing the joint with a sterile saltwater solution. Lavage helps remove tiny debris that may be irritating the joint. The arthroscope allows the surgeon to watch what he or she is doing on a TV screen during the procedure.
The majority of patients treated with arthroscopic debridement for elbow osteoarthritis have less pain and more motion after surgery. Symptoms may come back in some patients, but they are usually less severe.
Before the invention of high-quality artificial joints, surgeons used many techniques to keep the bone surfaces of arthritic joints from rubbing against each other. One of these techniques is distraction interposition arthroplasty. This procedure involves placing a piece of tendon or fascia between the bony surface of the elbow joint. (Fascia is a connective tissue, similar to tendon, that lies in a flat sheet. It covers the muscles and acts as a divider between different compartments of the body.)
As the joint heals, the tendon or fascia forms a cushion of thick, tough tissue between the bones. The tissue pads the ends of the bones and reduces pain while still allowing the elbow to move.
Interposition arthroplasty is rarely indicated but may be used in rare cases. It works fairly well in the elbow. It doesn't work very well in the weight-bearing joints of the hip, knee, and ankle.
Related Document: GT Physical Therapy's Guide to Interposition Arthroplasty of the Elbow
A fusion surgery (also called arthrodesis) eliminates pain by making the bones of the joint grow together, or fuse, into one solid bone. Fusions were very common before the invention of artificial joints. Even today, joint fusions are commonly used in many different joints to get rid of the pain of arthritis.
An elbow fusion will greatly decrease the motion in your arm. However, it does leave you with a strong and pain-free elbow. People who need a good range of motion in their elbow should consider another type of operation, such as an elbow joint replacement.
Related Document: GT Physical Therapy's Guide to Elbow Fusion
Elbow Joint Replacement
Elbow joint replacement or total elbow arthroplasty (TEA) is not nearly as common as hip, knee, or shoulder replacement. This is true for a couple of reasons. Osteoarthritis in the elbow is not as common as osteoarthritis in weight-bearing joints.
Elbow Joint Replacement
Elbow joint replacement also has a higher complication rate than the more common replacement surgeries. Infection and slowed healing in the surgical incision are two complications of this type of procedure. Fracture, dislocation, and loosening are other problems reported with total elbow arthroplasty (TEA).
The elbow joint replacement is a good choice for patients who need improved motion rather than strength. Older patients who don't need as much strength will probably prefer the results of elbow replacement surgery. They must be willing to accept low levels of activity involving the elbow. Patients with advanced rheumatoid arthritis are also good candidates for total elbow arthroplasty (TEA).
Related Document: GT Physical Therapy's Guide to Artificial Joint Replacement of the Elbow
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