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Find out how this condition can be treated and what to expect from your recovery
The elbow is a hinge joint that connects the humerus (upper arm bone) to the radius and ulna (forearm bones). The joint allows flexion (bending the elbow) and extension (straightening the elbow) movements as well as supination and pronation (turning your palm up and down).
The elbow is made up of three bones and a multitude of soft tissue structures that are important for the stability, movement and function of the elbow.
Like every other joint in the body, the elbow joint can be subjected to arthritis. Elbow arthritis can be caused by rheumatoid arthritis, elbow trauma and normal age-related changes (primary elbow arthritis) among other less common conditions.
Primary elbow osteoarthritis represents 1 to 2% of all elbow arthritis, with the majority of cases of symptomatic elbow arthritis coming from trauma or rheumatoid arthritis. Elbow arthritis tends to involve three main processes.
Firstly, the breakdown of the cartilage, followed by the development of osteophytes, bony growths or bone spurs that can develop in joints as the joint attempts to heal itself. Finally, progressive joint capsular contracture ensues.
Advanced arthritis then leads to destruction of the joint space, which can result in a number of potential symptoms:
There are a number of different treatments available for elbow arthritis including medication, activity modification, physiotherapy exercises, hot/cold therapy and corticosteroid injections.
However, if the pain and limitation in function becomes severe enough surgery can be necessary. Total elbow replacement surgery is usually avoided unless in elderly patients with severe pain and functional restriction due to the likelihood of component loosening and the need for revision surgery.
Open elbow debridement surgery is performed under general or regional anaesthetic as day surgery, meaning you will usually be operated on and released on the same day. Usually a nerve block will be administered in order to reduce the feeling in your elbow.
The surgery is performed as an open procedure, rather than arthroscopically, requiring an incision approximately 7-10cm long on the back of your elbow. The triceps muscles are then split and important structures such as the ulnar nerve are preserved.
The surgeon will then remove excess soft tissue, bone or osteophytes from the joint in order to allow improved function. At the end of the surgery the structure will be preserved and closed using dissolvable sutures. After the operation you will return to the ward wearing a collar and cuff until the nerve block wears off. You will have a soft bandage around your elbow.
The procedure is carried out before the start of your operation. You will have a small plastic tube placed in your arm (drip). Then you may have some sedation to make you feel relaxed. A small numbing injection in the skin is placed prior to the block needle (which is smaller than a blood-taking needle). Your arm will then start to feel very heavy and numb (a similar sensation to when you have been lying on it). This spreads down the outside of the arm (and spares the inside).
Surgery is then carried out under sedation (you are comfortable, relaxed and either awake or sleeping if you prefer) or occasionally under general anaesthesia (you are unconscious and unaware). If you are awake, you are welcome to watch the procedure on a TV screen, and we will explain to you what is happening. If you require any extra pain relief during the procedure, we can easily give you this through your drip. The block will reduce the overall amount of painkilling drugs that you will require during and after the operation.
The numbness will usually last for between 8 and 24 hours (depending on anaesthetic mixture used). We will leave your arm in a sling; please protect your arm whilst it is numb.
You will initially experience some ‘pins and needles’ as the block wears off and then some pain. Please prepare for this by taking the painkillers that we provide. Start these before the block wears off and expect to need them regularly for around 48hrs.
Occasionally we may recommend that at the time of the block we also place a small tube (catheter) that is fixed in place and through which we can give you further local anaesthetic to prolong your numbness for a few days. We would recommend this in situations where your pain after the operation is likely to be severe.
Anaesthesia is fairly safe for most people. If your health is not good the risks may be increased. Commoner complications include nausea and sore throat.
Local anaesthetic nerve blocks are generally considered to be safe. There is an approximately 5% (1 in 20) chance that they will fail or not work as well as expected. They tend to cause a small pupil and droopy eyelid temporarily and you may notice a hoarse voice or slight breathlessness.
Rare complications include reactions to the local anaesthetic solutions and nerve injury (the risk of temporary nerve symptoms e.g. tingling, numbness or weakness for a limited period is around 1 in 100 blocks and the overall risk of permanent injury approximately 1 in 5,000- 10,000 injections).
Paracetamol and an anti-inflammatory drug (if suitable for you – usually ibuprofen or diclofenac) are often used in combination. Take these regularly for the first few days.
Your anaesthetist will talk to you about strong painkillers, usually codeine, tramadol, oxycodone or morphine. Take these if your pain is poorly controlled (instructions will be on the packet). Some patients experience light-headedness when taking stronger painkillers; so be careful especially at first (rest up after taking them, don’t carry hot drinks or anything sharp) and take them only to counteract severe discomfort. Nausea and constipation can also occur, so drink plenty of water and increase the fibre in your diet; occasionally laxatives may be required (available from chemists).
If you are discharged on the same day as your operation, there should be someone keeping an eye on you during the first 24 hr period. If the painkillers make you excessively drowsy, then your carer needs to rouse you and ensure you not too sensitive to them.
Emergency contact numbers will be available on your discharge information if you or your carer wishes to talk to a trained member of staff.
The risks of open elbow debridement replacement surgery will be discussed with you in detail at your pre-admission clinic appointment. Risk factors for open elbow debridement surgery which can affect a very small percentage of patients include:
Once the effects of the anaesthetic and nerve block have worn off pain killers will be used to control your pain. The arm should be elevated as much as possible for the first few days to prevent the hand and fingers swelling. The dressing will be removed soon after your operation. The wound is cleaned and redressed with a simple dressing.
You should notice an improvement in symptoms within a few weeks but full recovery can take up to 3-6 months. Avoid forced gripping or heavy lifting for 2-3 weeks.
In order to return to driving, your hand needs to have full control of the steering wheel and if your left arm was operated on then also the gear stick. In terms of returning to work it will depend on your work environment.
Returning to heavy manual labour should be prevented for approximately 4-6 weeks. Early return to heavy work may cause problems with your recovery. You will be given advice on your own particular situation.
You will be reviewed by your consultant approximately 6-8 weeks after your surgery. Immediately after your surgery you will be referred for outpatient physiotherapy. You will follow a regimented physiotherapy programme that will allow you to start to regain movement in your elbow and then strengthen the muscles in order to return to all of your normal activities as follows: