Elbow Arthritis is degenerative joint disease of the elbow that can be broken into three main types: osteoarthritis, post-traumatic arthritis and inflammatory arthritis. Diagnosis can be made with plain radiographs of the elbow. Treatment can be nonoperative or operative depending on patient activity demands, severity of elbow pain and degree of elbow dysfunction. Etiology Osteoarthritis epidemiology incidence login to view 1 more bullet demographics login to view 3 more bullets location login to view 1 more bullet risk factors login to view 1 more bullet pathophysiology etiologies include login to view 6 more bullets pathoanatomy login to view 5 more bullets Post-traumatic arthritis epidemiology second most common etiology of arthritis (rheumatoid historically the most common) common after nonoperatively treated radial head fractures, elbow/fracture dislocations, and traumatic instability. more common in younger patients compared to other etiologies (inflammatory and primary arthritis) pathoanatomy direct articular cartilage damage surface incongruency alters load distribution across the bearing surface may encompass entire joint or may be isolated to specific areas of the ulnohumeral and/or radiocapitellar articulartion degenerative changes and early onset arthritis result as a consequence of the above may be accompanied by stiffness, chronic instability, malunion, or nonunion Inflammatory arthritis epidemiology rheumatoid arthritis login to view 4 more bullets other causes login to view 3 more bullets pathophysiology inflammation, chronic synovitis, ligament attenuation, periarticular osteopenia, capsular contracture pathoanatomy login to view 8 more bullets Anatomy Primary stabilizing factors of elbow anterior band MCL anterior oblique fibers most important stabilizes to both valgus and distraction forces LCL articular congruity between the olecranon, coronoid, and trochlea Secondary stabilizers radial head most important provides 30% of valgus stability most important in 0-30° of flexion and pronation capsule primary restraint to distraction forces in full extension anconeus, and lateral capsule secondary stabilizer to varus force Complete elbow anatomy and biomechanics Presentation Elbow osteoarthritis symptoms progressive pain, typically at end range of motion, not mid-range loss of terminal extension painful locking or catching of elbow night pain unusual physical exam loss of elbow range of motion (terminal extension) login to view 1 more bullet ulnar neuropathy in up to 50% of patients Elbow inflammatory arthritis symptoms hand and wrist involvement usually precedes elbow pain and loss of motion physical exam may have fixed flexion contracture ligamentous incompetence can be seen +/- ulnar neuropathy evaluate cervical spine in all rheumatoid arthritis patients Imaging Radiographs recommended views ap/lateral of elbow, cervical radiographs recommended for RA patients prior to surgery findings elbow joint space narrowing login to view 1 more bullet osteophytes found at login to view 3 more bullets loose bodies (underestimated on plain radiography) periarticular erosions and cystic changes seen in RA login to view 1 more bullet CT scan useful for surgical planning can help better define osteophytes and loose bodies Treatment Nonoperative NSAIDS, cortisone injections, resting splints, and activity modification indications login to view 1 more bullet Operative arthroscopic debridement and capsular release indications login to view 4 more bullets contraindications login to view 2 more bullets technique login to view 2 more bullets complications login to view 3 more bullets ulnohumeral distraction interposition arthroplasty indications login to view 3 more bullets technique login to view 3 more bullets complications login to view 2 more bullets olecranon fossa debridement (Outerbridge-Kashiwagi procedure) indications login to view 1 more bullet technique login to view 4 more bullets complications login to view 1 more bullet column procedure - medial or lateral open capsular release and bony resection indications login to view 2 more bullets total elbow arthroplasty indications login to view 4 more bullets contraindications login to view 3 more bullets complications (as high as 43%) login to view 6 more bullets Techniques Total Elbow Arthroplasty technique guide Column procedure - limited lateral open capsular release and bony resection approach a limited lateral based incision along the lateral distal supracondylar ridge arthrotomies anterior arthrotomy accomplished through ECRL/Common extensor interval login to view 2 more bullets posterior arthrotomy accomplished by elevating triceps from the posterior aspect of the humerus login to view 1 more bullet Complications Total complication rate may be as high as 43% Infection and/or wound healing complications Risk factors prior elbow surgery prior infection (esp. S. epidemidis) psychiatric co-morbidity rheumatoid arthritis wound drainage re-operation (any reason) poor skin quality (e.g. long term steroid use) Two-stage revision arthroplasty: poor survival Ulnar nerve neuritis/injury Can be iatrogenic injury or after restoration of elbow motion without nerve decompression Triceps avulsion Fracture Aseptic loosening Risk factors linked implants post-traumatic osteoarthritis Implant failure (mechanical) Instability Risk factors unlinked implants