Introduction

Elbow arthritis may be surgically treated with a procedure called interposition arthroplasty. With interposition surgery, the surgeon places new soft tissue between the damaged surfaces of the elbow joint. The soft tissue forms a false joint.

Rationale

The main goal of interposition surgery is to ease pain where the surfaces of the elbow joint are rubbing together. A piece of tendon or other soft tissue forms a "spacer" separating the surfaces of the joint. Interposition arthroplasty is different than a fusion surgery. Fusion simply binds the joint together, and the elbow loses much movement. Interposition arthroplasty can help take away pain while allowing the elbow joint to retain some movement.

Surgical Procedure

Surgery can last up to ninety minutes. Surgery may be done using general anesthesia, which puts you completely to sleep, or local anesthesia, which numbs only the arm.

The surgeon will make an incision along the back of your elbow. The incision is made on the back side because most of the blood vessels and nerves are on the inside of the elbow. Entering from the back side helps prevent damage to them.

The tendons and ligaments are then moved out of the way. Special care is taken to move the ulnar nerve, which runs along the elbow to the hand. Once the ends of the joint are exposed, scar tissue and bone spurs (small points of bone) are removed.

The surgeon will shape the ends of the elbow joint to make space for new tissue between the joint surfaces.

The surgeon then removes a rectangular-shaped piece of fascia tissue from the side of your thigh. (Fascia is a flat connective tissue that wraps around your muscles and organs.) This sheet of tissue is generally folded three times and sewn onto the end of the humerus bone. The new tissue forms a pad to separate the joint surfaces of the elbow.

Once the new piece of tissue is in place, the soft tissues over the joint are sewn back together.

Metal pins are then placed through the humerus and ulna bones. The pins stick out through the skin. A hinged elbow brace is attached to the pins to hold the surfaces of the elbow joint slightly apart. This device is worn for four to six weeks after surgery.

As with all surgical procedures, complications can occur. Some of the most common complications are infection, nerve or blood vessel damage, and infection.

After Surgery

Your elbow will be bandaged and supported by a movable splint. The splint holds the surfaces of the joint apart slightly as they heal. Your surgeon will want to check your elbow within five to seven days. Stitches will probably be removed after ten to fourteen days. There may be some discomfort after surgery. Your doctor can give you pain medicine to control the discomfort.

Your elbow should be kept elevated above the level of your heart for several days to avoid swelling and throbbing. Keep your elbow propped up on a stack of pillows when sleeping or sitting.

Rehabilitation

After surgery, you'll wear the elbow brace for up to six weeks to give the elbow time to heal. A physical or occupational therapist will most likely direct your recovery program. You may need to attend therapy sessions for one to two months, and full recovery may take up to four months.

The first few therapy treatments will focus on controlling the pain and swelling from surgery. Heat treatments may be used. Your therapist may also use gentle massage and other hands-on treatments to ease muscle spasm and pain.

Then you'll begin gentle range-of-motion exercises. Strengthening exercises are used to give extra stability to the elbow joint. As with any surgery, you need to avoid doing too much, too quickly.

Some of the exercises are designed to get your arm working in ways similar to your work tasks and daily activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your elbow joint. Before therapy sessions end, the therapist will teach you a number of ways to help avoid future problems.