Update on the Treatment of Elbow Arthritis

Osteoarthritis (OA) can affect the major joints of the body, including the elbow. Elbow OA is fairly rare but can be disabling. In this article, the authors review tests used to diagnose elbow OA and current treatment options.

Treatment is divided into two basic types: nonsurgical and surgical. The decision about which way to go with treatment depends on what stage of disease is present. There are three stages: early, intermediate, and late.

Each stage is defined by symptoms and changes in the joint seen on X-rays or CT scans. For early elbow OA, there is mild pain with a small loss of motion. Treatment is nonoperative and consists of change in activity, antiinflammatory drugs, and physical therapy. If symptoms persist, then steroid injections may be the next step.

For patients in the intermediate stage of elbow OA, there is moderate pain with a greater loss of motion. There may be nerve symptoms when the patient can no longer extend the elbow fully. The nerve gets pinched by bone spurs or overgrown cartilage.

In both mild and intermediate stages, the patient is taught to avoid activities and positions that put a high amount of stress, force, or load on the elbow. Surgery may be needed when there's been no improvement or very little change over a six month period of time.

There are several surgical options to choose from. The surgeon may débride the joint. This means any bone spurs, frayed soft tissues, or loose bodies are removed from in or around the joint. Another name for this procedure is ulnohumeral arthroplasty.

The joint capsule may be released or partially removed. This operation is called a capsular arthroplasty. If the nerve is entrapped by scar tissue, the surgeon may gently release the constrictive tissue from around the scar. This is a risky operation as nerve damage occurs easily.

The authors describe four surgical procedures and their clinical outcomes in detail. These include: arthroscopic débridement, open ulnohumeral arthroplasty, distraction interposition arthroplasty, and total elbow arthroplasty (TEA). TEA is an elbow joint replacement.

Over the years, it has been observed that the long-term success of TEA is limited. Problems with instability and loosening have been reported. Fracture of the implant and dislocation of the elbow are common. Younger patients who have higher functional demands on the elbow are especially at risk for these complications.

Older adults who have not been helped by conservative care may be the best candidates for TEA. They must be willing to accept a lower activity level. There are several types of TEA available. Common implant designs are presented with a discussion of the surgical technique for each implant system. Diagrams and photos are provided.

A review of the literature shows that improvements in the débridement techniques have made this a better treatment choice over TEA. Arthroscopic surgery has reduced the rate of nerve injuries. Future studies of elbow OA may include ways to improve surgical techniques and implant design.

References: Emilie V. Cheung, MD, et al. Primary Osteoarthritis of the Elbow: Current Treatment Options. In Journal of the American Academy of Orthopaedic Surgeons. February 2008. Vol. 16. No. 2. Pp. 77-87.