Osteoarthritis

Epidemiology

 

Relatively rare

 

Average age 50

 

Men 4:1 Women

 

Usually dominant arm

 

Aetiology

 

Primary

- associated with strenuous manual labour

 

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

 

Pathology

 

Begins radiocapitellar joint

 

Progresses to ulnohumeral joint

 

Forces across joint about 1/2 body weight

- increased in strenuous work

- small cross sectional area

- increases contact stresses

 

Clinically

 

Often have end range pain

- minimal in mid range

- pain when olecranon and coronoid osteophytes impinge

 

X-ray

 

May have well preserved radiocapitellar and ulnohumeral joints

 

Osteophytes olecranon and coronoid

 

Elbow OA LateralElbow OA AP

 

CT

 

Useful in defining antomy pre operation / identification loose bodies

 

Elbow Arthritis CT

 

Elbow Loose Bodies CTElbow Loose Bodies CT 2

 

MRI

 

Useful in detecting early chondral damage

 

MRI Radiocapitellar OAMRI Ulna Trochlea OA

 

Arthroscopy

 

Capitellar Chondral InjuryRadial Head Chondral DamageUlna Chondral Damage

 

DDx

 

Inflammatory arthritis / RA

- minimal osteophytes

- severely arthritic joint spaces

- have pain throughout range of motion

 

Management

 

Non operative

 

Analgesia

HCLA

 

Operative

 

1.  Open procedures

 

A.  Open capsular releases

- for stiffness

- releases as required

 

See Elbow / Stiffness

 

B.  OK procedure

- removal of coronoid and olecranon osteophytes

 

See Elbow / Stiffness

 

2.  Arthroscopic Osteochondroplasty and Releases

 

Anterior joint

- remove loose bodies

- resect coronoid osteophytes

- anterior capsular release to improve extension

- +/- radial head resection

 

Posterior joint

- remove loose bodies

- resect olecranon osteophytes

 

See Elbow / Arthroscopy

 

3.  Total elbow arthroplasty

 

Indications

- > 65

- sedentary

 

Results

 

? reduced long term survival compared to RA

 

Bjord-Tilde et al J Should Elbow Surg 2009

- Norwegian Joint Registry

- 469 RA revision rates 7% at 5 years and 15% at 10 years

- OA numbers small (24) with 5% revision rate at 5 years, 10 year not available