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Arthritis and Total Elbow Replacement Surgery What is Elbow Arthritis and Total Elbow Replacement Surgery? According to the Arthritis Foundation, arthritis is one of the most prevalent health problems in the United States. It is the second leading cause of work disability, after heart disease, and accounts for more than a half million hospitalizations annually. There are many different kinds of arthritis, several of which can affect the elbow joint. Among these are osteoarthritis, rheumatoid arthritis, and fibromyalgia. A variety of treatments are available for arthritis, ranging from exercise and medication to surgery. In the most severe cases, surgery may be warranted to reduce the effects of arthritis and return function to the joint. Total joint replacement surgery is one surgical option available to these patients. It is designed to replace diseased portions of bone in the joint with a combination of plastic and metal components, therefore reducing the pain and swelling associated with the friction in the joint. Arthritis is a term that refers to over 100 different specific related diseases. The term means, literally, “swelling of the joint.” This can be caused by any number of things, depending on the type of arthritis. The specific cause of arthritis is not known for most forms, however. Several different types of arthritis can affect the elbow: Rheumatoid arthritis is a systemic disease involving the immune system, affecting more than 2 million people in the United States. In rheumatoid arthritis, the body mistakenly believes the cartilage in the joints to be foreign bodies, and attacks it. The joints become inflamed, which causes pain and limits movement. Osteoarthritis is a degenerative disease that usually affects weight-bearing joints such as the hip and knee, and is more prevalent in persons older age 45. In osteoarthritis, the cartilage that covers the bones in the joint becomes diseased, causing pain and stiffness. The elbow is a complicated mechanism, made up of several bones, muscles and ligaments, all working together to provide an incredible range of motion and stability. The elbow joint is a hinge joint: the end of the humerus (upper arm bone) forms joints with the ends of the ulna and radius, the two bones in the forearm. Both the ulna and radius begin at the wrist and meet again at the elbow. The ulna is smaller at the wrist, and widens towards the elbow. The end of the humerus has two rounded points, called “processes,” that form a deep groove, for the ulna to slide in. The “hinge” of the elbow is formed by these two bones, allowing the elbow to bend and straighten. Another “joint” is formed by tip of the radius, called the radial head, and another part of the end of the humerus, called the capitulum. These bones meet end-to-end and form a swivel joint, allowing a twisting movement in the arm. The variety of movement that the combination of these two joints provide is what allows you to position your hands for use in reaching, grasping, and turning. The bones are covered with a layer of smooth cartilage, which allows the surfaces to slide easily over each other. The joint is also surrounded by a capsule, filled with synovial fluid, which aids in reducing friction. Several tendons and muscles attach each bone, providing stability. The ulnar collateral ligament is composed of three separate bands of tissue, connecting the humerus and ulna from three separate points, forming a triangle. The annular ligament surrounds the head of the radius, keeping it in the joint. The radial collateral ligament attaches the radius and humerus, end-to-end. Finally, the lateral ulnar collateral ligament attaches the ulna to the humerus. During flexion, the ulnar head slides against the capitulum like a hinge. Additional stability in the joint is provided by the various ligaments that connect the bones together. Reasons for Total Elbow Replacement Surgery? In a normal elbow, the abovementioned bones, tendons and muscles all work together to provide stability during an incredible range of motion. The cartilage-covered surfaces of bone are smooth and shiny, allowing each to move against the other with minimal friction. When any of these surfaces become diseased, however, the normally smooth surface becomes rough, causing friction and pain. Arthritis causes the cartilage to break down, causing the bones to rub against each other. When this happens, scar tissue and bone spurs may also develop, which leads to further pain and stiffness. Rheumatoid arthritis is the most common type of arthritis that can attack the elbow, though it will often strike both elbow and shoulder together, as well as other joints. Because it is a systemic disease, it will generally affect more than one joint, and there will be swelling of the elbow as well as other joints. Osteoarthritis causes the smooth, protective cartilage that coats the surface of the bones to become diseased and rough. Without this cartilage, the bones rub together during movement, causing increasing stiffness and pain as bone grinds against bone. Before a total joint replacement will be considered, more conservative treatment options will be explored, depending on the type of arthritis. Because diet may be a factor in arthritis, your doctor or a dietitian may work with you to better regulate your diet, including losing weight if you are above your ideal weight, as the extra stress on joints can aggravate your arthritis. Exercise will also be recommended, as part of keeping the body healthy and strong. Exercise builds muscle and increases flexibility, which can protect joints from the progression of arthritis. Your doctor may also prescribe medication to ease pain, and/or reduce inflammation. These may include aspirin or NSAIDs (Non-steroidal anti-inflammatory drugs) such as ibuprofen. Surgical Procedure for Total Elbow Replacement? The surgeon will most commonly use what is known as a lateral approach to the joint. You will lie, face-up, with your arm across your body supported by a bolster. The surgeon will make an incision about 10 cm along the back of your elbow, from just below the tip of your elbow, up the back of the upper arm. Another approach provides the opportunity to access the joint from both the lateral (the surface of the arm facing away from the body) and the medial (the surface facing towards the center of the body) surfaces of the joint. This incision will be just towards the inside surface (medial) of the arm, and will be approximately 18 cm in length. Once the surgeon has exposed the humerus and ulna, she will prepare the surfaces of both the humerus and ulna. There are many different kinds of prosthetics, and the surgeon will choose one based on the type of arthritis you have and the degree of impairment in the joint. There are basically two different types of prosthetics: constrained, and semi constrained. A constrained prosthesis consists of both ulnar and humeral components, linked together to form a hinge. The two pieces are attached to each other, whereas in a semi constrained prosthesis they permit some movement between the two pieces. Both components consist of a stem portion, made of a metal alloy, with the hinge portion at the end. This stem is inserted into the bone, and may be fixed with screws, depending on the design. There is a wide variety of types of prosthetic components available, and your surgeon will select a type and size based on your particular joint and its condition. The goal of elbow arthroplasty is to both eliminate pain and to reduce friction, increasing range of motion. By removing the damaged bone and replacing it with prosthetic parts that function more smoothly, surgery can provide a better alternative to living with the debilitating effects of arthritis. Rehabilitation of Total Elbow Replacement Surgery? A successful total elbow replacement surgery can mean a return to activity that you may have given up because of severe pain. You will not have a perfect, full-functioning elbow after the surgery, but with a strong commitment to physical therapy, you will certainly have better use of your elbow than when you did with arthritis. After six months of physical therapy, you will have almost full function of your elbow and very limited pain. Possible Complications of Total Elbow Replacement Surgery? As with any surgery, you must weigh the risks and potential benefits, and decide whether or not to have the surgery performed. Because this is not a life or death decision, it is solely your decision to make. Some of the potential risks include:
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