Lateral elbow resurfacing for arthritis

The condition

2.1 Rheumatoid arthritis is the most common form of arthritis in the elbow. Osteoarthritis that needs surgery is less common in the elbow than in weight-bearing joints, such as the knee and hip. Symptoms include pain, swelling and stiffness in the elbow.

Current treatments

2.2 Treatment for elbow arthritis depends on the severity of the disease. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility. When symptoms are severe, surgery may be indicated. Options include arthroscopic debridement, interposition arthroplasty, replacement or excision of the radial head, or total elbow replacement.

The procedure

2.3 Lateral resurfacing of the elbow for arthritis is usually done under general anaesthesia. The patient is typically placed on their side with the elbow uppermost. An incision is made in the back of the elbow and the triceps muscle is split to access the elbow joint. The joint is dislocated, and the articular surfaces prepared. The capitellum of the humerus is sized, and then after inserting a guidewire the capitellum is reamed using a surface cutter, and a peg hole is then created. A trial component is inserted. A guidewire is then inserted into the radial head and the surface is shaped with a cutter to produce a concave face. A peg hole is then created in the radial head and a trial component inserted. Once the trial components have been tested for stability and range of movement and there is a satisfactory result, the definitive components are implanted and the joint reduced. The triceps and other soft tissues are repaired, and the skin is closed with sutures. A cast or splint is used for 4 to 6 weeks after which function is gradually resumed.

2.4 A potential advantage of this procedure over a total elbow replacement is that it preserves the natural inner compartment of the elbow. Movements are therefore likely to be more like a natural elbow joint.