Marc Darrow MD,JD

We have seen many patients over the years with problem elbows. We see some whose problems have extended beyond a tennis or golfer’s elbow problem, into one of osteoarthritis, and a recommendation for an elbow replacement surgery. Elbow replacement surgery is certainly not as popular as knee, hip and shoulder replacement, but it is performed and by the acknowledgement of surgeons, it is a tricky surgery.

An April 2021 paper (1) gives a brief overview of the different types of elbow surgery specific to elbow osteoarthritis:

“The surgical management of primary elbow arthritis has evolved because of an improved understanding of pathologic mechanisms and manifestations as well as the development of novel surgical techniques and devices. Osteocapsular arthroplasty (Arthroscopic osteocapsular arthroplasty of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain, (2), elbow debridement (cutting away damaged tendon tissue and removal of bony overgrowths), distraction arthroplasty (the bones of the elbow are pulled apart to allow cartilage to regrow – the bones are typically held in place with pins, screws and rods that are outside the skin), and total elbow arthroplasty (elbow replacement) have been employed for managing elbow osteoarthritis. Elbow debridement and osteocapsular arthroplasty can be helpful in most cases of symptomatic elbow arthritis. Total elbow arthroplasty is usually recommended for end-stage arthritis in elderly patients after prosthetic implants have been in place for long periods or after complications. Distraction arthroplasty might find a place in the treatment of younger, active patients with end-stage arthritis.”

This are not, as you can see from their simple descriptions, simple procedures.

High complication rates and need for elbow replacement revision

An October 2020 study (3) spoke of high complication rates and need for elbow replacement revision. Here is what the study published:

  • Total elbow arthroplasty (replacement) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications.
  • The expansion into the procedure include more osteoarthritis patients, specifically post-traumatic osteoarthritis patients.
  • In previous research, three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the post-traumatic injury group.
  • Complication and revision rates varied
    • rheumatoid arthritis anywhere from 5 – 30% complications and 11-13% of the patients needed revision surgery.
    • Injury / trauma group anywhere from 14.2-50% complications and 0-30% of the patients needed surgery.
    • Osteoarthritis 50% complications following surgery and 11% of the patients needed revision

Like a knee replacement, elbow replacement can come in total or partial types depending on the level of elbow joint degeneration. The need for an elbow replacement, also like a knee replacement can depend on the elbow’s ability to move through normal motion.

Sometimes the elbow replacement causes osteoarthritis

When someone suffers a significant elbow injury and the bones are broken, as in a radial head fracture (where the radius of the forearm meets the humerus of the upper arm) the elbow is dislocated or displaced, the ligaments and tendons are damaged, and surgery cannot put the elbow back together again, the patient will undergo a radial head arthroplasty or replacement.

A January 2021 study (4) examined the incidence of post-traumatic elbow osteoarthritis (humeroulnar and humeroradial joints) after radial head arthroplasty and identify its risk factors.

  • Seventy-three patients were included in the analysis with a average age of 56.
  • The injuries consisted of 41 terrible triad, elbow dislocation, a radial head fracture, and a coronoid process fracture.
  • 15 isolated radial head fractures,
  • 11 Monteggia fractures (a 1/3rd size break in the ulna and dislocation of the radial head)
  • and 6 transolecranon fracture-dislocations (break and dislocation of the the bony prominence of the elbow, on the upper end of the ulna.

At the final assessment, elbow osteoarthritis incidence after radial head arthroplasty was 56% in the humeroulnar joint and 72% in the humeroradial joint. Radial head arthroplasty implant placement, posterior subluxation immediately postoperative and the duration of immobilization were significantly corelated with osteoarthritis.

Stem Cell Therapy for Elbow Osteoarthritis

Stem Cell Therapy is the injection into the elbow of stem cells that have been drawn from the patient’s own bone marrow or other sources. Stem cells are “de-differentiated pluripotent” cells, which mean that they continue to divide to create more stem cells; these cells eventually “morph” into the tissue needing repair—for our purposes, collagen, bone, and cartilage.

The excitement in the medical community is focused on how stem cells work, rebuilding the damaged part of the body from within by turning a diseased joint environment into a healing joint environment. Doctors and researchers are hopeful that they have finally found a possible answer for osteoarthritis in the promise of Stem Cell Therapy.

There is at this time no research papers on the use of stem cell therapy for elbow pain. Empirically we see many patients with elbow problems and have been able to help many reduce or eliminate their pain and improve function.

Numerous studies support the healing effects of stem cells. In one study (5), doctors tracked patients for five years after they had received stem cell injections for knee osteoarthritis. At the end of the five-year follow-up period, the knees of patients who had been treated with stem cells were still better than they had been before treatment.  At five years, we would have to call that a “curative effect.”

Research has shown that bone marrow stem cells increase the cell proliferation of chondrocytes and inhibit inflammatory activity in osteoarthritis—in other words, according to the researchers, stem cell injections cause the regrowth of cartilage and halt damaging chronic inflammation.(6)

Stem Cell Therapy can be useful not only for the regrowth and repair of cartilage damage, but also for the repair of bone damaged by osteoarthritis. In animal studies, doctors found that stem cells injected into the site of a bone fracture promoted rapid and accelerated bone healing.(7)

The research into Stem Cell Therapy has helped revolutionize the way standardized medicine addresses problems of bone degeneration and necrosis (bone death). Cartilage can be regrown, bone can be regrown, and chronic inflammation (swelling) can be shut off.

Realistic assessment of effectiveness of stem cell therapy for elbow osteoarthritis.

From many people stem cell therapy will be a great benefit in helping them with their elbow pain. For others, stem cell therapy will have limited or no success. How would you know? You would need an assessment and then a physical examination from an office will experienced in stem cell therapy as a treatment option.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

 

References:

1 Kwak JM, Jeon IH. Surgical management for primary osteoarthritis of the elbow. Journal of Orthopaedic Surgery. 2021 Feb 10;29(1):2309499020988174.
2 O’Driscoll SW, Blonna D. Osteocapsular arthroplasty of the elbow: Surgical technique. JBJS essential surgical techniques. 2013 Sep;3(3).
3 Samdanis V, Manoharan G, Jordan RW, Watts AC, Jenkins P, Kulkarni R, Thomas M, Rangan A, Hay SM. Indications and outcome in total elbow arthroplasty: A systematic review. Shoulder & Elbow. 2020 Oct;12(5):353-61.
4 Antoni M, Ginot G, Mereb T, Clement X, Eichler D, Kempf JF, Clavert P. Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors. Orthopaedics & Traumatology: Surgery & Research. 2021 Jan 19:102814.
5 Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int. J. Rheum Dis. 2015 May 20. doi: 10.1111/1756-185X.12670.
6 Zhang Q, Chen Y, Wang Q, Fang C, Sun Y, Yuan T, Wang Y, Bao R, Zhao N. Effect of bone marrow-derived stem cells on chondrocytes from patients with osteoarthritis. Mol Med Rep. 2016 Feb;13(2):1795-800. doi: 10.3892/mmr.2015.4720.
7. Huang S, Xu L, Zhang Y, Sun Y, Li G. Systemic and local administration of allogeneic bone marrow derived mesenchymal stem cells promotes fracture healing in rats. Cell Transplant. 2015; 24(12):2643-55. doi: 10.3727/096368915X687219.

 

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