We have seen many patients over the years with problem elbows. We see some whose problems have extended beyond a tennis or golfer’s elbow problem, into one of osteoarthritis, and a recommendation for an elbow replacement surgery. Elbow replacement surgery is certainly not as popular as knee, hip and shoulder replacement, but it is performed and by the acknowledgement of surgeons, it is a tricky surgery.
As the elbow is a hinged joint similar to the knee, elbow osteoarthritis share many of the same characteristics and treatment suggestions that someone with knee osteoarthritis would get. There are treatments for pain that include pain medications and anti-inflammatories. Physical therapy and exercise would be recommended if the elbow locks up. Like the knee, extensive elbow braces and sleeves may be worn. Eventually if an MRI is “bad” enough, an arthroscopic procedure would be recommended. Ultimately the medical journey would end with an elbow replacement.
Elbow replacement is considered a more rare surgery but as people are remaining active longer, elbow replacement is becoming much more frequent.
An April 2021 paper (1) gives a brief overview of the different types of elbow surgery specific to elbow osteoarthritis:
“The surgical management of primary elbow arthritis has evolved because of an improved understanding of pathologic mechanisms and manifestations as well as the development of novel surgical techniques and devices. Osteocapsular arthroplasty (Arthroscopic osteocapsular arthroplasty of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain, (2), elbow debridement (cutting away damaged tendon tissue and removal of bony overgrowths), distraction arthroplasty (the bones of the elbow are pulled apart to allow cartilage to regrow – the bones are typically held in place with pins, screws and rods that are outside the skin), and total elbow arthroplasty (elbow replacement) have been employed for managing elbow osteoarthritis. Elbow debridement and osteocapsular arthroplasty can be helpful in most cases of symptomatic elbow arthritis. Total elbow arthroplasty is usually recommended for end-stage arthritis in elderly patients after prosthetic implants have been in place for long periods or after complications. Distraction arthroplasty might find a place in the treatment of younger, active patients with end-stage arthritis.”
This is not, as you can see from their simple descriptions, simple procedures.
High complication rates and need for elbow replacement revision
An October 2020 study (3) spoke of high complication rates and need for elbow replacement revision. Here is what the study published:
- Total elbow arthroplasty (replacement) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications.
- The expansion into the procedure include more osteoarthritis patients, specifically post-traumatic osteoarthritis patients.
- In previous research, three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the post-traumatic injury group.
- Complication and revision rates varied
- rheumatoid arthritis anywhere from 5 – 30% complications and 11-13% of the patients needed revision surgery.
- Injury / trauma group anywhere from 14.2-50% complications and 0-30% of the patients needed surgery.
- Osteoarthritis 50% complications following surgery and 11% of the patients needed revision
Like a knee replacement, elbow replacement can come in total or partial types depending on the level of elbow joint degeneration. The need for an elbow replacement, also like a knee replacement can depend on the elbow’s ability to move through normal motion.
Sometimes the elbow replacement causes osteoarthritis
When someone suffers a significant elbow injury and the bones are broken, as in a radial head fracture (where the radius of the forearm meets the humerus of the upper arm) the elbow is dislocated or displaced, the ligaments and tendons are damaged, and surgery cannot put the elbow back together again, the patient will undergo a radial head arthroplasty or replacement.
A January 2021 study (4) examined the incidence of post-traumatic elbow osteoarthritis (humeroulnar and humeroradial joints) after radial head arthroplasty and identify its risk factors.
- Seventy-three patients were included in the analysis with a average age of 56.
- The injuries consisted of 41 terrible triad, elbow dislocation, a radial head fracture, and a coronoid process fracture.
- 15 isolated radial head fractures,
- 11 Monteggia fractures (a 1/3rd size break in the ulna and dislocation of the radial head)
- and 6 transolecranon fracture-dislocations (break and dislocation of the the bony prominence of the elbow, on the upper end of the ulna.
At the final assessment, elbow osteoarthritis incidence after radial head arthroplasty was 56% in the humeroulnar joint and 72% in the humeroradial joint. Radial head arthroplasty implant placement, posterior subluxation immediately postoperative and the duration of immobilization were significantly corelated with osteoarthritis.
Injections for Elbow Osteoarthritis
Bone marrow derived stem cell injections are cells that have been drawn from the patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which mean that they continue to divide to create more stem cells; these cells eventually “morph” into the tissue needing repair—for our purposes, collagen, bone, and cartilage.
1 Kwak JM, Jeon IH. Surgical management for primary osteoarthritis of the elbow. Journal of Orthopaedic Surgery. 2021 Feb 10;29(1):2309499020988174.
2 O’Driscoll SW, Blonna D. Osteocapsular arthroplasty of the elbow: Surgical technique. JBJS essential surgical techniques. 2013 Sep;3(3).
3 Samdanis V, Manoharan G, Jordan RW, Watts AC, Jenkins P, Kulkarni R, Thomas M, Rangan A, Hay SM. Indications and outcome in total elbow arthroplasty: A systematic review. Shoulder & Elbow. 2020 Oct;12(5):353-61.
4 Antoni M, Ginot G, Mereb T, Clement X, Eichler D, Kempf JF, Clavert P. Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors. Orthopaedics & Traumatology: Surgery & Research. 2021 Jan 19:102814.
5 Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int. J. Rheum Dis. 2015 May 20. doi: 10.1111/1756-185X.12670.
6 Zhang Q, Chen Y, Wang Q, Fang C, Sun Y, Yuan T, Wang Y, Bao R, Zhao N. Effect of bone marrow-derived stem cells on chondrocytes from patients with osteoarthritis. Mol Med Rep. 2016 Feb;13(2):1795-800. doi: 10.3892/mmr.2015.4720.
7. Huang S, Xu L, Zhang Y, Sun Y, Li G. Systemic and local administration of allogeneic bone marrow derived mesenchymal stem cells promotes fracture healing in rats. Cell Transplant. 2015; 24(12):2643-55. doi: 10.3727/096368915X687219.