What are the surgical options for management of arthritis involving the elbow joint?
- • Inflammatory arthritis not responsive to medical management, synovectomy will temporarily control the disease and reliably decrease pain, but it infrequently has any positive effect on joint motion. Open synovectomy may also include excision of the radial head if significantly involved. However, total elbow arthroplasty is preferred to radial head resection/synovectomy in most patients. Arthroscopy is used for diagnostic purposes, removal of loose bodies, and synovectomy for both biopsy and treatment purposes.
- • OA: the ulnohumeral articulation is predominantly affected, usually by osteophytes that develop on the coronoid process or olecranon. Surgically, these osteophytes are removed arthroscopically or through an open incision. When the articular cartilage is lost, the joint surface can be resurfaced with autologous tissue, fascia lata most commonly.
- • Posttraumatic arthritis involving the radiohumeral or proximal radioulnar joint, a radial head excision can be performed with predictably good results as long as the medial collateral ligament of the elbow is intact.
Total elbow arthroplasty is becoming the surgical option of choice for most arthritic conditions of the elbow. This is attributable to the increasing reliability of the current prostheses and the magnitude of functional improvement for a patient. Overall pain relief is 90% with long-term complications of 10%, most commonly loosening. Elbow arthrodesis should be a very last resort because this procedure makes it impossible to position the hand for functional use. It is reserved for an end-stage arthritic elbow from previous septic arthritis and in patients when total elbow replacement is not feasible.