By Daniel Koehler, M.D.
Daniel Koehler, M.D.
The treatment of elbow arthritis can be complicated, and the condition can have debilitating effects for patients.
In a study published in the Journal of Hand Surgery, Michael A. Del Core, M.D., and I reviewed the principles of diagnosis and treatment of elbow arthritis, a relatively uncommon condition, reaffirming that options for surgery versus conservative therapy must be carefully selected based on the patient’s symptoms, physiologic age, and functional demands.
Our research also confirmed that the type of treatment recommended should strongly consider the condition that caused the arthritis, with the three most common being:
- Rheumatoid arthritis, a systemwide inflammatory disorder known for progressive articular destruction and loss of bone, as well as deterioration of ligaments and instability
- Posttraumatic arthritis, which develops in response to an initial cartilage injury or secondary to residual incongruities, even in surgically treated fractures
- Primary osteoarthritis, which typically develops in the dominant arm of patients with high-impact, repetitive-use occupations
Many patients achieve symptom relief without surgery, and conservative treatment begins with activity modification, anti-inflammatories, and physical therapy to help maintain mobility and strength. If patients still have pain or low function after nonsurgical treatment, surgery may be appropriate.
Recommended surgeries, by condition
Five types of surgical procedures are recommended for elbow arthritis, based on cause:
- Debridement: For patients with mild to moderate posttraumatic or primary osteoarthritis, impingement pain, or terminal loss of motion
- Synovectomy: A joint-preserving type of debridement recommended for early-stage rheumatoid arthritis to reduce pain and swelling and improve range of motion
- Total Elbow Arthroplasty: For older patients with severe arthritis and lower functional demand
- Interpositional Arthroplasty: For younger patients with severe arthritis and higher functional demand
- Arthrodesis: To salvage the joint and reduce severe pain or instability
After setting appropriate expectations with the patient, the recommended procedure should be based on a patient’s age, functional goals, and symptom severity. The primary treatment goals are to reduce pain and improve function.