I am considering surgery for a bad case of elbow osteoarthritis. I'd like to know up front what to expect before going this route. What kind of results do people get? What happens down the road?
In almost all cases, doctors recommend nonsurgical treatment first for any joint osteoarthritis. Surgery is usually not considered until it has become impossible to control your symptoms. The goal of nonsurgical treatment is to help you manage your pain and use your elbow without causing more harm. But if you have already tried all the various options (e.g., antiinflammatory medications, physical therapy, splinting, activity modification, steroid injections), then surgery may be the only option left. Surgical options range from arthroscopic release of the muscle contracture to debridement and removal of the head of the radial bone at the elbow. Debridement refers to the scraping away of loose bone, bone spurs, and opening up the narrowed joint space. Some surgeons have developed their own special techniques to deal with the problem. For example, there is the open Outerbride-Kashiwagi (OK) procedure or the ulnohumeral arthroplasty procedure. These are two additional ways to perform debridement. Studies comparing open incision surgery versus arthroscopic (minimally invasive) approaches are ongoing. There is evidence that open surgery provides greater range of motion, while arthroscopic surgery reduces pain more. An overall review of the studies done show that decreased pain, increased motion, improved function, and patient satisfaction are reported no matter what type of surgery is done. But long-term studies also show that the disease process continues unstopped. More bone spurs develop. Pain and stiffness eventually return. Some hand surgeons tell their patients to expect "modest" and "unpredictable" improvements. They are honest and forthright in saying the osteoarthritis won't go away but will get worse over time. It is clear we need more research to find better ways to treat this problem. Understanding the underlying cause and pathology of the disease might help scientists find a way to prevent the disease in the first place or at least stop the progression of disease once it starts.