Primary Elbow Osteoarthritis: Evaluation and Management

Abstract

Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity . Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages . When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures . The ulnar nerve needs to be carefully assessed and addressed at the time of surgery . Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice . Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.

Fig. 1

Anteroposterior (a) and lateral (b) radiographs of demonstrate primary elbow osteoarthritis.

Fig. 2

Computed tomography with two-dimensional images (a–b) and three-dimensional reconstruction (c–d) is extremely useful for the evaluation and surgical planning of patients undergoing arthroscopic osteocapsular arthroplasty and other joint debridement procedures.

Fig. 3

A and B. Arthroscopic osteocapsular arthroplasty.

Fig. 4

When patients with primary elbow osteoarthritis are considered for total elbow arthroplasty, a high-performance implant should be selected.