While there are many methods to treat arthritis of the elbow, eventually the elbow may become so painful that fusion surgery or arthrodesis is recommended.
What is an Elbow Fusion?
Fusion eliminates pain by allowing the bones of the joint to grow together, or fuse, into one solid bone. Fusions were very common before effective artificial joints were available and are still performed.
The radius bone of the forearm is not included in the fusion to allow patients to turn their hands palm up and palm down. The joint between the ulna and the radius is what allows this movement.
An elbow fusion results in a strong but immobile elbow joint. Regaining strength is especially important to young people who work with their hands doing labor-intensive activities. These patients need strength more than flexibility for gripping and carrying. Patients who need more movement than strength may consider another type of operation such as an artificial elbow joint replacement.
An elbow fusion begins by making an incision down the back of the elbow. Since most of the blood vessels and nerves are on the other side of the elbow, this helps prevent injury to these structures.
Next, the tendons and ligaments on the back side of the elbow joint are moved to the side to allow the surgeon to see the joint surfaces of the elbow. Care must be taken to protect the nerves that run beside the elbow joint on their way to the hand. The articular cartilage surface of each side of the joint is then removed.
Most elbow fusion operations remove the articular cartilage from the joint surfaces and then hold the two surfaces together until they heal. When two raw bone surfaces are brought together, the body begins to form bone to heal the two pieces of bone together even if the two surfaces were once a joint. In this way, a strong connection can be made between the two bones instead of a painful arthritic joint.
Your surgeon may use bone graft from your pelvic bone to help the fusion heal. To accomplish this, two incisions will be made, one on the back of the elbow and another smaller incision over the pelvic bone.
The humerus and the ulna must be held in proper alignment until the two bones can heal together and fuse. One popular method is to place a metal plate with screw holes on the back of the elbow from the humerus to the ulna. The metal plate is not removed unless it causes problems. At the end of the operation, the incisions are sutured together and the arm is placed in a large splint or cast.
An external fixator may also be used to hold the bones together. This type of procedure is sometimes chosen if the elbow fusion is the result of an infection in the elbow joint. To use the external fixator, the surgeon places metal pins through both the humerus and the ulna above and below the joint. The external fixator device holds the bones together by connecting these metal pins together outside the skin using metal rods and bolts. A metal screw between the ulna and the humerus may be used to compress the bones together as well.
Once the fusion is solid the metal pins and rods can be removed. This usually occurs in about 12 weeks.
As with all major surgical procedures, complications can occur. Some of the most common complications following elbow surgery are explained below.
Infection. All operations carry a small risk of infection. You will probably be given antibiotics before the operation to reduce the risk of infection. If an infection develops, you will most likely be treated with antibiotics. You may need additional operations to drain the infection if it involves the area around the bone graft and metal plate.
Nerve and blood vessel injury. All of the nerves and blood vessels that go to the forearm and hand travel across the elbow joint. Because the operation is performed so close to these important structures, it is possible to injure either the nerves or the blood vessels during surgery. The result may be temporary, for instance, if nerves have been stretched by retractors that held them out of the way during surgery. It is uncommon to have permanent injury to either the nerves or the blood vessels, but it is possible.
Non-union. Sometimes the bones do not fuse as planned. If the motion from a non-union continues to cause pain, you may need a second operation to completely fuse the bones. This usually means adding more bone graft and making sure that any plates or metal pins that have been used are holding the bones still to allow the fusion to occur.