If you have arthritis in one or both of your elbows, your doctor has likely prescribed medications and daily exercises in an attempt to keep you pain-free. But if those measures aren't giving you enough relief, you might start looking into other options to control your elbow pain.
Several surgical procedures can reduce your pain and increase the range of motion in your elbow. Possibilities range from arthroscopic procedures that require small incisions and short recovery times to complete surgical replacement of your elbow joint.
But deciding whether surgery is right for you involves a careful balance between the risks of surgery and the improvement you can expect. Understanding the risks and benefits of each type of surgery can help you in your discussions with your doctor about what's right for you.
Open surgery refers to the traditional method of operating — making an opening in your body through a large incision to access the target site. In the case of elbow surgery, the surgeon inspects and repairs your elbow joint through this large opening. Open surgery is widely available because surgeons have been doing it for many years.
In arthroscopic elbow surgery, the surgeon makes small incisions though which he or she inserts a tiny camera and light to look inside your elbow. The image is projected onto a monitor outside your body. The surgeon uses the images on the monitor to guide him or her through the surgery, which is conducted through the tiny incisions. Because the incisions are smaller than those of open surgery, recovery time is generally shorter.
Arthroscopic surgery requires special expertise because the surgeon is moving the tiny camera and surgical tools within millimeters of nerves in your elbow. Also, if your elbow has deteriorated from arthritis, your risk of arthroscopic complications is increased. Depending on the stage of your arthritis, arthroscopic surgery might not be an option. Because arthroscopic elbow surgery is still evolving, it isn't available at all medical centers.
Arthroscopy: A boon for damaged joints
Some surgical procedures are performed only by means of open surgery. Others must be performed arthroscopically. Still others can be performed using either technique.
The specific procedure that's right for you will depend on several factors, including the type of arthritis — osteoarthritis or rheumatoid arthritis — and the condition of your elbow. Here are some of the more common surgical options.
Synovectomy involves removal of the inflamed synovial tissue around the elbow that is causing you pain and swelling. It's usually the first choice in surgery for people with early stages of rheumatoid arthritis. You might consider synovectomy if you've tried medication and therapy for at least six months and you still have severe pain in your elbow.
The synovectomy procedure can be open or arthroscopic. Because arthroscopy allows your surgeon to see and access more of your joint, arthroscopic synovectomy is more thorough.
The synovium in your joints eventually grows back, which means that your elbow pain could return in a few years. Medications can prevent your synovium from becoming inflamed again.
In debridement (da-BREDE-maw), your surgeon removes the debris on and around your joint that is causing you pain and making it hard to move your elbow. This debris includes bone spurs (osteophytes) and loose pieces of bone or cartilage.
Debridement is used to treat osteoarthritis and is usually the first surgery used after medications and physical therapy fail to bring relief from pain. Debridement can be performed as an open surgery or arthroscopically.
In interposition arthroplasty, your joint is resurfaced using a piece of your skin — usually from your abdomen — or a piece of a tendon from another part of your body, often the Achilles tendon. Interposition arthroplasty can only be performed as open surgery.
During interposition arthroplasty, your surgeon removes any bone spurs or loose pieces of bone. The surgeon dislocates your elbow and stitches the piece of skin or tendon in place between the bones that make up your elbow joint. This keeps your bones from rubbing together, thereby reducing your pain.
Complications of interposition arthroplasty can include infection and paralysis of nerves in the elbow. Interposition arthroplasty lasts as long as 20 years. You might need a total elbow replacement later in life.
If you're under age 60 and have severe arthritis, you might consider interposition arthroplasty. Generally people younger than 60 aren't offered elbow replacement surgery, so interposition arthroplasty is performed as an intermediate surgery between debridement or synovectomy and total joint replacement.
Interposition arthroplasty is gradually being replaced with a new arthroscopic procedure called osteocapsular arthroplasty.
Osteocapsular arthroplasty is a more thorough form of debridement. It includes the removal of bone spurs, loose bone and loose cartilage. But it also includes synovectomy and recontouring of bones that have become deformed or have deteriorated because of arthritis. Though osteocapsular arthroplasty can be extremely successful, it's also very difficult to perform. Because it's relatively new and requires substantial expertise, osteocapsular arthroplasty isn't widely performed.
Elbow replacement — also called total elbow arthroplasty — is usually reserved for people with advanced arthritis. If you have intolerable pain that doesn't respond to medication and your daily activities are limited by your arthritis, you might consider elbow replacement.
Elbow replacement is generally done in older adults — those 60 and older — and it isn't recommended for younger people unless other types of surgery have failed. One reason is that younger, more active people might be inconvenienced by the restrictions of elbow replacement — such as not lifting anything weighing more than 10 pounds.
When you have elbow replacement surgery, the surgeon removes parts of the bones in your elbow and replaces them with a metal prosthesis similar to a hinge. Replacing the diseased bones and tissue relieves pain and restores range of motion.
After making an incision in the back side of your elbow, the surgeon moves your muscles and nerves out of the way. He or she then reshapes your bones to accept the artificial joint, and cements the new elbow joint into place.
As with any surgery, elbow replacement carries the risk of infection and bleeding. Also, the metal joints can loosen from the bone, which would need to be corrected with another surgery. Injury to the nerves in your elbow is also possible.
Elbow replacement surgery can increase range of motion in your elbow and reduce pain. But your use of the new elbow is subject to severe limitations. After surgery, you shouldn't lift more than one or two pounds regularly, and lifting up to 10 pounds can only be done occasionally. Heavier lifting could damage the new joint or the bones holding it in place. These restrictions are in place for the life of your new joint.
Many people with arthritis have pain and loss of motion in several joints. Joints that bear weight and those necessary for everyday tasks are usually fixed first. Generally the knees and hips are prioritized for surgery, followed by hands and wrists. Elbows are next on the list. The order in which your joints should be repaired will depend on your condition.
Edwin D. Vyhmeister MD, C. Hendrik Kirchhoff MD and Harold J. Kirkpatrick MD - Providing services in hand and wrist injury surgery, tennis elbow and shoulder therapy and tendinitis treatment to the areas of Everett and Seattle, Washington.
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