Surgical management for primary osteoarthritis of the elbow

Abstract

The objective of this review is to summarize the surgical options for primary osteoarthritis of the elbow, reported clinical outcomes, and suggested indications in previous literatures. 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 (OCA), elbow debridement, distraction arthroplasty, and total elbow arthroplasty (TEA) have been employed for managing elbow osteoarthritis. Elbow debridement and OCA can be helpful in most cases of symptomatic elbow arthritis. TEA 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.

Postoperative Rehabilitation of Elbow Pain

“…These symptoms include pain at the terminal range of motion, mechanical symptoms (such as impingement, locking, and crepitus), and stiffness [28]. The procedures involve steps such as capsular release, synovectomy, and the removal of osteophytes and loose bodies, all aimed at reducing pain and increasing range of motion [29].…”

The Surgical Treatment of Osteoarthritis

“…Osteo-capsular arthroplasty consisting of capsular releases and osteophyte removal, either performed openly or arthroscopically, is another feasible surgical option in young and active patients [ 36 ]. In radiocapitellar cartilage destruction, the resection of the radial head can be combined with the interposition of anconeus ( Figure 2 and Figure 3 ) or with radiocapitellar implant arthroplasty [ 37 , 38 ].…”

Primary Elbow Osteoarthritis: Evaluation and Management

“…35 Three factors seem to be significantly associated with increased DOUN risk: preoperative hypertrophic ossification, preoperative neurological symptoms, and severity of preoperative loss of motion. In cases of rapidly progressive ulnar neuritis (which is characterized by increasing pain in the cubital tunnel, progressive loss of elbow motion, and neuropathy), 36 urgent reoperation is recommended to transpose the ulnar nerve; if ulnar nerve transposition is delayed beyond 2 weeks after surgery, a complete recovery in neurological function may not occur.…”

“…With assistance from the contralateral hand, the patient gradually increases both extension and flexion, and nighttime splints may be considered for the first 3e4 weeks. 28,36…”

“…21,22,28 There are older patients with severe involvement of the joint line space when elbow arthroplasty is the only procedure that can provide adequate pain relief. 36 When elbow arthroplasty is considered for patients with primary osteoarthritis, consideration should be given to implantation of a high-performance implant (Fig. 4).…”