Elbow replacement surgery can be challenging, not only because the elbow is a relatively small and complicated hinge joint, but also because next-generations arthritis drugs have generated healthier patients who require long lasting, more durable treatments, involving joint replacement surgery.
Surgical alternatives are only regarded when medications and other measures do not relieve critical joint pain and loss of mobility. Here is a general review of the most common kinds of elbow operations. They can be done arthroscopically, using smaller incisions and fiber-optic (camera) technology or as a conventional open method.
This procedure separates the synovium – the flexible membrane lining the joint. In a healthy elbow, the synovium makes a lubricating fluid that terminates friction as the arm moves. Anyhow, in rheumatoid arthritis (RA) and other forms of inflammatory arthritis, the synovium becomes inflamed, finally eroding cartilage and leading to pain and swelling. Separating the synovium temporarily stops this procedure. Synovectomy healing time relies on how the process was done and some tissues damaged. Rehabilitation takes a minimum of two months.
Best candidates: Patients in the early stages of inflammatory kind of arthritis with little or no cartilage injury.
Pros – Synovectomy can improve indications significantly. Performance and pain scores revamp, swelling goes down, and several patients return to near-normal work. Arthroscopic Synovectomy usually results in a quicker, less painful healing.
Cons – Synovectomy does not stop disease progression. After many years, the synovium begins to regrow, and indications usually come back. (The operation can be repeated). Also, nerve damage is a significant risk in arthroscopic elbow methods because the tight space is hard to navigate and major nerves are close to the joint.
This technique separates bony growths in the joint along with any loose bits of bones or cartilages. In some cases, the upper end or the head of the radius is also separated. Debridement is effectively used for post-traumatic and primary OA in the elbow. Recovery period – between 12 and 24 weeks (including rehabilitation) – relies on how the process is done and the age of the patient.
Best Candidates: Patients with mild to moderate OA who have stiffness and minor pain. Those with pain through their full range of motion or advanced illness are not good candidates.
Pros – Many people experienced 80% to 95% pain relief and increased the range of motion following the procedure. Open and arthroscopic methods have equally successful results, but arthroscopic skills, which have better considerably in the past decade, are connected with faster recovery and less pain.
Cons – Bony developments tend to recur and range of mobility decreases over time, though several people continue to undergo significant pain relief. Like arthroscopic synovectomy, arthroscopic debridement delivers a risk of nerve damage for even the well-trained elbow arthroscopist.
Elbow Inter-Positional Arthroplasty
The aim of interposition arthroplasty is to relieve pain that appears when bone surfaces rub together. The ends of the bones are rebuild, and a small section of the patient's Achilles tendon or another soft tissue is fitted into the space between the joint surfaces. Recovery period, including recovery and rehabilitation, can be up to 4 months.
Best candidates: Active people with primary OA, post-traumatic OA or inflammatory arthritis who have too much injury for debridement but are too young for the elbow joint replacement. We might regard this operation in a younger, patient with an active career, like a school teacher who can no long write on the blackboard. Adding that candidate for the procedure also must have a stable elbow (with ligaments that are not too loose to hold the bones in place) with minimal bone loss.
Pros – Interposition Arthroplasty can relieve critical pain while retaining some elbow work, and unlike an artificial joint, implanted tissue will not loose or dislocate. Bone stock is also preserved, which is important if elbow replacement is required in the future.
Cons – The procedure does not entirely relieve pain or replace full function and cannot be done on some patients with the critical disease.
Total Elbow Arthroplasty or Replacement
Similar to hip or knee replacement, this operation replaces injured parts of the elbow with plastic components. A connected implant consists of two metal stems – one in the Humerus and one in the ulna – fixed by a cobalt-chrome hinge pin that articulates with the joint. In an unlinked prosthesis, the humeral and ulnar components are not mechanically fixed, depending instead on the surrounding tissue for joint stability. Linkable transplants give the surgeon the alternative of leaving the transplant linked or unlinked, relying on what is found during the operation. The average healing period is a minimum of 12 weeks.
Best candidates: They were originally older, less active adults with end-stage inflammatory arthritis. Anyhow, elbow transplants are now also used for OA and post-traumatic OA. Because they do not last more than a few years, they are not suggested for people less than the age of 60.
Pros – Elbow replacement can effectively relieve pain and restore lost mobility and function in people with critically injured and damaged joints.
Cons – The complex rate for elbow replacement is higher than for any other joint. Connected implants can assure a stable elbow, even with a critical bone loss, but tend to loosen and wear out swiftly. Unlinked transplants dislocate easily and for that reason are used less frequently. High overall failure rates – 25% fail within 5 to 7 years – are due in parts to poor tissue quality in the joint and, paradoxically, to the effects of better arthritis drugs.
These are some of the key elbow replacement surgery options and each options has its own pros and cons. The elbow replacement cost also varies depending on the type of surgery. The treatment choice would ultimately depend on the severity of the injury and other health aspects of the patient.
Kimmie Rollison is an eminent Health consultant. She also writes for the Health columns for various regional and international online media and blogs. She is currently writing for Orthopaedic Surgery India (http://orthopaedicsurgeryindia.com/), a medical tourism company dealing with bone and joint treatments in India.