Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I dislocated my left elbow during a wrestling tournament in high school. The orthopedic surgeon put it back in place for me so I didn't have to have surgery. But then I mangled the same elbow in a motocross accident about five years ago. So now at age 35, I have arthritis worse than my grandma. I asked my doctor about an elbow replacement. She said I am 'too young' for that. She gave me a prescription for some antiinflammatories. Is that all I can do?

Answer:

Joint replacements are available now for the elbow. But it's a tricky joint made up of three separate bones and two distinct joints. And it is responsible for repetitive motion of the hand and arm as well as rotation of the forearm, and weight-bearing activities through the hand and wrist. Because of the high activity demand on a replacement implant and its limited lifespan, total elbow replacement (TEA) isn't usually recommended for young patients. In fact, it is considered a salvage procedure -- in other words, only used as a last resort to save the joint. Before considering a total elbow replacement (TEA) in anyone younger than 40 years of age, all other avenues of treatment should be explored. This usually consists of conservative (nonoperative) care as well as surgery. Conservative care starts with medications (antiinflammatories) such as were prescribed by your physician. Injections (e.g., steroid or hyaluronate injections) might give some temporary or short-term relief from pain. But usually, physical therapy to reduce pain, increase joint motion, and improve function is tried first. If three to six months of conservative care fail to bring the desired results, then surgery may be the next step. Surgical procedures available include: 1) debridement (surgical cleaning) of the joint, 2) interpositional arthroplasty (remove part of the joint and fill in with tendon or other graft tissue), or 3) partial arthroplasty (only part of the joint is replaced). These approaches are used in the management of young adults who have developed degenerative arthritis following injury to the elbow (like your situation). How does the surgeon decide which procedure to use for each patient? Well, the key is to evaluate each and every patient individually. There is not a one-solution-fits-all kind of treatment or management approach. As with conservative care, the goals of surgical treatment are to reduce pain and improve elbow function. Patients can be divided into two groups based on history and physical examination. The first group are individuals who have a painful, stiff elbow joint at the end-ranges of motion (full flexion and/or full extension). These patients seem to do best with the less invasive debridement procedure. Debridement can be done arthroscopically (minimally invasive approach) or with an open incision. Patients with pain any time they move the elbow and who have X-ray or CT signs of advanced joint degeneration are better candidates for a more involved surgical procedure. With many choices for surgical approaches, the surgeon must carefully review all aspects of each case. The most appropriate candidates for TEA are patients with painful elbow motion and X-ray evidence of joint destruction who have failed all other attempts at treatment. Before using an elbow implant to replace the diseased, degenerated joint, the patient must agree to limit lifting to less than 10 pounds for a single item and less than two to five pounds for repetitive loads. Activities and weight-bearing restrictions will also be advised. The patient who receives a TEA can expect a stable joint with near normal elbow motion. Complications and problems are fairly common though and the patient must be prepared for this possibility. The implants just haven't held up on long-term studies. Loosening requiring revision (a second surgery) happens more often than anyone would like. Patients often outlive their implants. The bushings wear out, the parts crack and break apart or come loose. Any of these events will require another surgical procedure. Since you are just starting treatment with the antiinflammatory medications (the necessary and appropriate first step), this might be more information than you need right now. But it may help you understand your physician's initial treatment approach and judgment regarding elbow replacement. Keep this information in mind when you go back for follow-up care -- it will help you ask some additional questions about the best plan of care for you. Benjamin W. Sears, MD, et al. Posttraumatic Elbow Arthritis in the Young Adult: Evaluation and Management. In Journal of the American Academy of Orthopaedic Surgeons. November 2012. Vol. 20. No. 11. Pp. 704-714.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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