Total elbow joint replacement for elbow arthritis: Surgery with a dependable, time-tested prosthesis can lessen pain and improve function in elbows, especially in rheumatoid arthritis of the elbow

Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, June 20, 2008

Figure 1 - X-ray of elbow showing the humerus, radius, and ulna

Figure 2 - X-ray of elbow showing the humerus, radius, and ulna

Review of the condition

What are some general characteristics of elbow arthritis? What are its usual manifestations?

What are the different types of elbow arthritis?

How is elbow arthritis diagnosed? What tests or exams may be used?

Rheumatoid arthritis of the elbow must be distinguished from other causes of elbow pain, including infection, other types of arthritis, and conditions involving the nerves of the arm. These distinctions can be made by a physician experienced in the evaluation of elbow problems.

While not as common as severe arthritis of the hip, knee, or shoulder, rheumatoid arthritis of the elbow is among the most prevalent causes of severe pain and loss of function of the elbow. Individuals with rheumatoid arthritis involving one joint are likely to have involvement of other joints as well.

A physician diagnoses rheumatoid arthritis of the elbow by reviewing the patient's history, performing a thorough physical examination of the joint, and taking the proper X-rays. The examination of an arthritic elbow reveals stiffness and roughness of the joint.

X-rays of the elbow reveal the contour of the joint surfaces and the status of the cartilage space between them. X-rays of an arthritic elbow usually show narrowing of the space between the bones of the lower end of the humerus (arm bone) and the upper end of the radius and ulna (forearm bones)--often to the point that bone is touching bone, as shown in figures 1 and 2.

It is essential that the elbow surgeon establish the diagnosis of arthritis before elbow joint replacement is considered.

Can medications help elbow arthritis?

Medications are helpful in managing rheumatoid arthritis. Some people take anti-arthritic medications for their entire lives. Specific drugs may treat the inflammation that destroys the cartilage. Some of these medications are administered by injection and others by mouth. These medications can be quite helpful, but there may be side effects. These medications should be taken under the close supervision of a rheumatologist or other physician experienced in their use.

The patient should be aware of the possible side effects of these medications, including stomach irritation, kidney problems, and bleeding. Injections of steroids (cortisone) or lubricants (such as hyaluronic acid) into the elbow have not been demonstrated to have lasting benefit and carry some risk of infection.

For each medication, patients should learn:

1. the risks,
2. possible interactions with other drugs,
3. the recommended dosage, and
4. the cost.

Can exercises help elbow arthritis?

If exercises are not too painful, they may be helpful in maintaining the flexibility and strength of joints with arthritis. In most cases these exercises can be done in the patient's home with minimal equipment. Elbow exercises are best performed gently several times a day on an ongoing basis. These usually include bending and straightening the elbow as well as rotating the forearm so the palm faces up and then down. Often the exercises will be of benefit in the earlier phases of the condition. The exercises are not dangerous if they are performed gently.

Sometimes physical therapists suggest other types of therapy. Patients should learn the possible risks of these approaches as well as their costs and anticipated effectiveness.

Specifically, how is elbow arthritis improved by elbow replacement surgery?

Elbow joint replacement arthroplasty offers the opportunity for people to regain much of the lost comfort and function in an arthritic elbow. In experienced hands, this procedure can address the restricting scar tissue that frequently accompanies arthritis. It also can restore smooth, stabilizing joint surfaces when these surfaces have been damaged by arthritis.

Joint replacement surgery can improve the mechanics of the elbow, but cannot make the joint as good as it was before the onset of arthritis. In many cases, the tendons and muscles around the elbow have been weakened from prolonged disuse before the elbow replacement. The scar around them needs to be removed. After the surgery, it may take months of gentle exercises before the elbow has achieved maximal improvement.

The effectiveness of the procedure depends on the health and motivation of the patient, the condition of the elbow, and the expertise of the surgeon. When performed by an experienced surgeon, total elbow replacement arthroplasty usually leads to improved elbow comfort and function. The greatest improvements are in the ability of the patient to sleep and to perform activities of daily living.

Surgery for Elbow arthritis at the University of Washington

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