Elbow Arthritis – Osteoarthritis

The elbow is a hinge-type synovial joint made up of three bones: humerus (upper arm bone), ulna (the larger bone of the forearm on the pinky side) and radius (the smaller forearm bone on the thumb side). It allows for:

• Flexion and extension(bending and straightening the arm)
• Pronation and supination(rotation of the forearm)

Despite its essential functions, the elbow is relatively small and lacks the large muscle groups that protect joints like the hip or shoulder, making it:

• Susceptible to trauma (e.g. fractures, dislocations)
• Prone to degenerative diseaseslike osteoarthritis

To a large extent, the stability of the elbow depends on the integrity of the joint itself.

Elbow arthritis is a chronic (long-term) condition that affects the elbow joint, causing pain, stiffness, swelling, and reduced motion. As the condition progresses, it may severely impair function, making daily tasks difficult and eventually leading to the need for surgical intervention, such as elbow replacement surgery. Women are more prone to elbow arthritis than men. This may be due to:

• Hormonal differences, especially post-menopause.
• Higher prevalence of autoimmune diseaseslike RA in women.
• Possibly genetic or anatomical differencesthat affect joint health.

The most common type of elbow arthritis is osteoarthritis i.e. the progressive degeneration and erosion of articular cartilage (the smooth surface that allows bones to glide over each other) that is often developed from wear and tear, injury, or overuse.

Elbow osteoarthritis is a degenerative joint disease where the cartilage in the elbow joint wears down over time. While it’s less common than arthritis in weight-bearing joints like the knees and hips, it can still cause significant pain and disability. The most common causes of elbow osteoarthritis are rheumatoid arthritis (RA), some type of injury or trauma (such as a fracture, dislocation or post-traumatic arthritis), and, very frequently, the natural aging (wear and tear) of the joint.

The main symptoms that indicate the onset of elbow arthritis are the following:

• Pain during movement or at rest
• Swelling and tenderness around the joint
• Stiffness and reduced range of motion
• Clicking or locking sensation
• Weakness in the arm or grip

If these symptoms are ignored or left untreated:

• The joint continues to deteriorate.
• Cartilage wears away, leading to bone-on-bone contact.
• Inflammation increases, worsening pain and stiffness.
• Joint deformity and instability can occur.

Neglecting the symptoms of elbow arthritis can lead to a worsening of the condition, resulting in significant limitations in elbow movement and daily activities. This can mean the elbow may no longer bend or straighten normally, and the patient may struggle with even simple daily tasks such as:

• Eating (bringing food to the mouth)
• Grooming (brushing teeth or combing hair)
• Dressing (putting on clothes)
• Carrying objects
• Typing or writing

The patient’s medical history and a simple clinical examination provide the initial diagnosis, which is confirmed with X-rays and Magnetic Resonance Imaging (MRI).

In the early stages, there are treatment options that can delay the progression of elbow arthritis and at the same time improve joint mobility. After specific tests, the doctor may proceed with one of the following injections:

• Hyaluronic acid injections
• Platelet-Rich-Plasma (PRP) injections (biological agents)

If non-surgical methods, including injections, do not relieve symptoms, and the condition progresses, surgical options may be considered. These may include:

1. A minimally invasive procedureusing small incisions and a camera to view the joint.
2. Key procedures during arthroscopy:

• Osteophytes (bone spurs) removal: Bone spurs are shaved down to improve movement and reduce pain.
• Debridement: Removal of loose cartilage, bone fragments, or inflamed tissue.
• Cartilage smoothing: Helps reduce joint friction.

The main advantages of elbow erthroscopy are the following:

• Less tissue damage compared to open surgery
• Faster recovery time
• Lower risk of complications
• Long-term symptom relief in many patients

Elbow arthroplasty or elbow replacement surgery, is a surgical procedure used to replace the damaged or worn-out parts of the elbow joint with artificial components (prostheses). It’s performed to alleviate pain and improve function in individuals with severe elbow arthritis, fractures, or other conditions that cause significant joint damage and limited mobility. It involves replacing the ends of the humerus (upper arm bone) and ulna (one of the forearm bones) with artificial components, typically made of metal and plastic implants. The most ideal candidates are elderly patients (typically over age 60) as these individuals are usually less active, placing less stress on the artificial joint. Younger, more active patients are generally not ideal candidates due to the higher risk of implant failure and loosening, especially with the smaller, less durable implants used in elbow replacements. The implants used in elbow arthroplasty are smaller and more delicate than those used in hip or knee replacements, and as a result, they have a shorter lifespan.

Are there any complications from elbow arthroplasty?

Elbow arthroplasty (elbow replacement surgery) is generally safe and effective, but like any surgery, it carries some risks and potential complications such as infection, fracture or loosening of the implant. Postoperatively, the patient must carefully follow the doctor’s instructions, as overuse of the joint may lead to the need for additional surgery and a recurrence of pain. These complications are rare nowadays, especially when the surgeon is experienced. The vast majority of patients who undergo surgery experience no complications.

How long does it take to fully recover after the procedure?

Patients typically begin gentle movements soon after surgery, usually guided by a physical therapist. Most patients can expect to regain full function and experience significant pain relief within about 2 months. During recovery, it’s crucial to avoid lifting heavy weights or placing excessive stress on the joint to protect the implant and surrounding tissues.