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elbow interposition arthroplasty

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Hi guys. I was wondering if anyone here has any experience with advanced elbow arthritis.

32M fyi

Long story short, I've had pain in my left elbow for a long time (10-15 years) and was misdiagnosed by multiple doctors as a torn bicep and tennis elbow. Last year I switched to a different PCP and he was like, it's not tennis elbow, get an MRI. That MRI revealed almost all of my cartilage had been ground away by some bone spurs on the ulna (IIRC) it may be even worse than that. The first doctor I saw said a total elbow replacement was needed, but I'm too young and active for one and he was an idiot. I saw another doctor a few months back and she said a partial elbow replacement may work but she hadn't even seen my MRI. Her office seems totally incapable to retrieve the MRI from the first doctor who is in the same medical group. She didn't express much confidence in her elbow expertise as well.

After searching and searching I think I found the best elbow doc in the PHX area, Dr Scott Edwards at the Core Institute and I'm seeing him on tuesday. What I'm going to ask him about is the topic of the thread. Basically they take an achilles tendon or some muscle fascia and put it into the joint, acting as a replacement for the worn cartilage. It seems to be the best option for young, active patients who aren't good candidates for total elbow replacement.

 

My elbow has gotten to the point where it freezes up and I lose a lot of motion. Not to mention its extremely painful. It seems to be getting worse and worse as well, sometimes it take a few days to regain motion but right now I'm going on 3 weeks and still haven't regained full use. Simply eating a steak hurts. 

Anyway, hopefully someone here has some experience with this stuff and can chime in.

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Post the X-ray.  Real world decisions are based on the X-ray.

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It really doesn't look that bad.  What is your range of motion.  An acceptable ROM is 30 degrees of fixed flexion  to anything over 130 degrees

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12 minutes ago, DrMark said:

It really doesn't look that bad.  What is your range of motion.  An acceptable ROM is 30 degrees of fixed flexion  to anything over 130 degrees

When looking at the MRI, I have bone on bone contact on the right side of the joint above, on the radial head. it must be from a fracture that healed wrong. "severe chondral thinning"

 

I don't exactly what my degrees are but it's more than 30 and much less than 130 degrees.

 

My other joint is perfectly fine. He recommended Excision of the radial head. I think that is my only option at this point.

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Excision of the radial head isn't an interposition arthroplasty. That's comparing a BB gun with a nuclear bomb.

Why don't you post a picture of the arm with the elbow as extended as possible and bent as much as possible.

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34 minutes ago, DrMark said:

Excision of the radial head isn't an interposition arthroplasty. That's comparing a BB gun with a nuclear bomb.

Why don't you post a picture of the arm with the elbow as extended as possible and bent as much as possible.

I was under the impression that it wasn't the radial head that was the problem. Can't change the title now. 

20170613_195716.jpg

20170613_195652.jpg

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I would be more likely to cut the anterior capsule to gain extension, debride the spurs and or loose bodies, that are preventing flexion, and doing a similar procedure on the posterior capsule, leaving the articular cartilage alone, without interposition of some thing in between the bones.  The recovery is speedier, and you don't burn any bridges as you would in an interposition arthroplasty.

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14 hours ago, DrMark said:

I would be more likely to cut the anterior capsule to gain extension, debride the spurs and or loose bodies, that are preventing flexion, and doing a similar procedure on the posterior capsule, leaving the articular cartilage alone, without interposition of some thing in between the bones.  The recovery is speedier, and you don't burn any bridges as you would in an interposition arthroplasty.

So basically grind down not on the radial head but on the humorous side so the radial head isn't coming in contact and causing pain?

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I have no reason to implicate the radial head here.  The elbow isn't perfect, but neither is a grinding operation or an interposition arthroplasty. I would do whatever it took to get motion back, and leave it like that.  A supple elbow with some arthritis is pretty functional in a young person, and the alternatives are worse.

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39 minutes ago, DrMark said:

I have no reason to implicate the radial head here.  The elbow isn't perfect, but neither is a grinding operation or an interposition arthroplasty. I would do whatever it took to get motion back, and leave it like that.  A supple elbow with some arthritis is pretty functional in a young person, and the alternatives are worse.

The MRI was very good, showing my radial head cartilage pretty much gone and rubbing bone. He said it would be highly unlikely to get motion back or get rid of pain without either doing an implant or excision of the radial head. It's toast.

We'll see.

 

 

I am getting a 2nd opinion from a doc he recommended here in the next few weeks.

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