Among the many possible outcomes of rheumatoid arthritis (RA), joint damage and destruction in the elbow can significantly impact mobility, dexterity, and quality of life.

Conservative approaches like nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may reduce inflammation and pain, but they cannot reverse joint damage. Moreover, serious RA-related complications such as infections, fractures, or ligament tears can occur even with appropriate medical management. In such cases, surgery may be necessary to restore elbow function and relieve symptoms.

Elbow arthroplasty, or the replacement of the damaged elbow joint with an artificial device, can be a highly effective treatment option for RA patients who have exhausted other options. This article will discuss the indications, types, benefits, and risks of elbow arthroplasty for RA patients.

Indications for Elbow Arthroplasty in RA Patients

Elbow arthroplasty is typically considered when RA patients suffer from the following:.

Severe and consistent pain, stiffness, or swelling that restrict normal activity and sleep
Limited range of motion, especially extension or flexion
Joint instability or deformity that cannot be remedied by conservative approaches
X-ray or other imaging evidence of bone damage, fragmentation, or erosion leading to significant bone loss or collapse
Failure of other treatments like NSAIDs, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), or physical therapy to relieve symptoms

Elbow arthroplasty is not recommended for patients with active infections, bleeding disorders, or severe neurological or immunological conditions that could interfere with the surgical procedure or healing process.

Moreover, some patients may not be suitable candidates for certain types of elbow arthroplasty due to their age, weight, bone quality, or other health factors. Therefore, careful evaluation and consultation with an experienced orthopedic surgeon are crucial before considering elbow arthroplasty.

Types of Elbow Arthroplasty

There are several types of elbow arthroplasty procedures depending on which parts of the elbow joint need to be replaced and how they are attached to the surrounding bones:.

Total elbow arthroplasty (TEA): This involves the replacement of both the humerus and ulna bones with prostheses that form a hinge-like joint. TEA is the most common type of elbow arthroplasty for RA patients.
Radial head arthroplasty: This involves the replacement of only the head of the radius bone with a smaller prosthesis that allows the elbow to rotate.
Interposition arthroplasty: This involves the placement of a tissue or synthetic buffer between the humerus and ulna to create a new joint surface. This technique is used for RA patients who still have some joint cartilage remaining and do not wish to undergo a TEA yet.
Hemi-arthroplasty: This involves the replacement of only one side of the elbow joint, usually the humeral component, with a metal or plastic prosthesis.

The choice of type of elbow arthroplasty depends on the patient’s individual condition, the extent of joint damage, the surgeon’s expertise, and the patient’s goals and preferences.

Some patients may need bilateral elbow arthroplasty if both elbows are affected by RA.

Benefits of Elbow Arthroplasty for RA Patients

Elbow arthroplasty can offer several benefits to RA patients who undergo the procedure, including:.

Pain relief: Most patients experience significant pain reduction after the procedure since the damaged bone and cartilage are removed, and a new, smooth joint surface is created.
Improved function and range of motion: Patients can gradually regain their ability to perform activities of daily living and motion ranges that were limited before the procedure. Physical therapy is crucial for optimizing these outcomes.
Prevention of further joint damage: The artificial joint can resist further bone erosion or collapse and maintain stability of the joint, reducing the risk of RA-related fractures or dislocations.
Improved quality of life: Patients who no longer suffer from constant pain, stiffness, or weakness can enjoy better sleep, mood, and social interactions.
Long-term durability: Elbow prostheses are designed to last for many years, even decades, if properly cared for and monitored.

Risks of Elbow Arthroplasty for RA Patients

Like any surgical procedure, elbow arthroplasty may entail some risks and complications, which may include:.

Infection: This is the most common complication associated with elbow arthroplasty, occurring in about 1-2% of cases. Antibiotics and proper hygiene can minimize the risk.
Loosening or instability of the prosthesis: This can happen if the bone and cartilage around the prosthesis do not heal properly or if the implant migrates or wiggles over time. Patients may need additional surgery to fix this issue.
Nerve damage: Some patients may experience temporary or permanent damage to the nerves that control elbow movement or sensation, resulting in numbness, tingling, or weakness.
Bone fractures: Fractures may occur as a result of the surgical procedure or due to weakened bone structure around the elbow joint. This risk is higher for patients with severe RA or osteoporosis.
Blood clots: Patients may develop blood clots in the legs or lungs after the procedure, which can be life-threatening if not treated promptly.

However, most of these complications are rare, and patients can take steps to minimize their occurrence by carefully following the surgeon’s instructions before and after surgery and attending regular follow-up appointments.

Conclusion

Elbow arthroplasty is a safe and effective treatment option for RA patients who experience joint damage and dysfunction that cannot be alleviated by non-surgical approaches.

Depending on the patient’s individual condition and preferences, different types of elbow arthroplasty can be selected to achieve the best possible outcomes. While there may be some risks associated with the procedure, careful follow-up and compliance with medical recommendations can significantly reduce them.

RA patients who are considering elbow arthroplasty should discuss the procedure in detail with their orthopedic surgeon to determine whether it is right for them.