Open elbow debridement

OK procedure
Summary

Short Summary

This operation is performed for pain, catching or stiffness caused by early arthritis.  When a joint develops arthritis the body forms extra bone around the joint called osteophytes.  This extra bone can impinge when the elbow is moved consequently causing pain and stiffness.  An open elbow debridement removes the osteophytes and releases the joint capsule to try and restore the movement and improve pain. 

Factors to Consider

Elbow arthritis usually causes pain at the limits of movement due to osteophytes abutting normal bone at these extremes.  This may progress to preventing you from getting your hand to your mouth or fully straightening your elbow.  Fragments caused by the arthritis can become loose and cause locking and catching in your elbow as well.  

It is likely that you have already tried non-surgical treatments for your elbow such as pain killers, lifestyle changes, physiotherapy and injections.  If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is usually performed through a 4 cm incision at the back of your elbow or over the outer aspect of the elbow.  The elbow is entered and the osteophytes causing the restriction in movement can be removed.  The joint capsule can also be released and a gentle manipulation performed to try and regain full range of movement.  The surgery can sometimes be performed via keyhole surgery or as a combination of keyhole and open.

The operation takes about 1 hour.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be about 0.5%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels around the elbow can occur but this is rare.  The elbow can develop stiffness after surgery.  This will usually improve with physiotherapy but full range of movement may not be occur If these measures have not improved your symptoms then the next logical step is to consider an elbow replacement.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage.  This can be removed 2 days following the surgery and is used to help with swelling.    There will be dressings applied to the wound under these bandages.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wounds are closed using non-dissolvable stitches.  The stitches will need to be removed at 10-14 days following surgery.  The nurses will arrange this to be done at your local GP practice before you are discharged.

You may be given a sling but this is only for comfort.  You can get rid of the sling as soon as you feel comfortable.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally takes about a week.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be improved/improving by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.