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Elbow Osteoarthritis

Osteoarthritis of the elbow — primary and post-traumatic, conservative and surgical options.

82 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Elbow osteoarthritis affects 2% of the population, with an average presentation age of 50 years and a male-to-female ratio of 4:1 [5]. Primary disease is associated with hand dominance and strenuous manual labor, while secondary causes include trauma, osteochondritis dissecans, and synovial osteochondromatosis [5]. The condition is characterized by periarticular hypertrophic osteophytes, capsular contracture, and loose bodies, which act as mechanical blocks at end ranges of motion [5]. Pathologically, the radiocapitellar joint is preferentially involved with relative preservation of the ulnohumeral surfaces and joint space [5]. Patients typically present with painful catching, clicking, or locking and loss of terminal extension and flexion, with pain localized to end ranges rather than midrange [5]. Forearm rotation remains relatively preserved until late in the disease process, and ulnar neuropathy is present in up to 50% of cases [5].

Nonoperative management with rest, NSAIDs, corticosteroid injections, and activity modification is the first step in early disease [3, 5]. Surgical intervention is indicated for failure of nonsurgical interventions, loss of motion interfering with activities of daily living, or painful locking [5]. The goal of treatment is to obtain low pain levels with sufficient motion for good function while preserving future surgical options and delaying arthroplasty [1]. Treatment must be individualized based on etiology, severity, patient age, and functional demands [6, 8, 12]. Joint-sparing procedures, including arthroscopic or open débridement, osteophyte excision, capsular release, and loose body removal, are preferred for most patients [5]. Total elbow arthroplasty is rarely indicated for primary osteoarthritis and is generally avoided in patients younger than 65 years or those who are physically active due to concerns regarding implant longevity [5, 79].

Arthroscopic osteocapsular arthroplasty and open débridement procedures are safe and effective for primary and posttraumatic elbow osteoarthritis, providing significant improvements in range of motion and clinical outcomes with low complication and reoperation rates [2, 4, 6, 7, 10, 13, 63]. While arthroscopic techniques offer favorable overall outcomes, open procedures may demonstrate better improvement in flexion limitation [110]. The Outerbridge-Kashiwagi procedure remains a viable option with excellent survivorship until conversion to total elbow arthroplasty [16, 20]. Complications of elbow surgery include deep infection at rates of 0.8% to 2.2%, transient nerve palsies in 1% to 3% of cases, and stiffness due to heterotopic ossification [5]. Total elbow arthroplasty remains associated with substantial complication and reoperation rates, with survival rates comparable to other elbow arthroplasties [42, 73].

Anatomy & Pathophysiology

Epidemiology and Demographics

Symptomatic primary osteoarthritis of the elbow affects approximately 2% of the population [5]. The condition predominantly affects middle-aged men who undertake heavy manual work [17].

Bony Anatomy and Joint Mechanics

The elbow is a trocho-ginglymoid joint consisting of the ulnohumeral, radiocapitellar, and proximal radioulnar joints [87, 120]. The ulnohumeral joint is highly congruous and functions as a hinge [87, 120], while the radiocapitellar joint allows for forearm rotation [57, 120]. The articular surface of the distal humerus is angled 30 degrees anterior to the humeral shaft axis [38, 39]. In full extension, 60% of axial load is transmitted through the radiocapitellar joint [38, 39].

Normal range of motion for elbow flexion and extension is 0 to 150 degrees [38, 39], and normal forearm pronation and supination is 80 to 85 degrees in each direction [38, 39]. The functional range of motion is defined as a 100-degree flexion/extension arc (30 to 130 degrees) and a 100-degree pronation/supination arc (50 degrees of supination and 50 degrees of pronation) [37, 133].

Specific bony landmarks include the olecranon fossa, an oval structure wider in the medial to lateral dimension [5], and the trochlea, which has a 300-degree arc of cartilage [57]. The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270 degrees of the articular margin [87]. Cartilage encircles approximately 240 degrees of the marginal radial head, with the lateral 120 degrees devoid of cartilage [120].

Ligamentous Anatomy and Stability

Elbow stability is determined by primary stabilizers (ulnohumeral articulation, medial ulnar collateral ligament, lateral ulnar collateral ligament) and secondary stabilizers (radiocapitellar articulation, common flexor tendon, common extensor tendon, joint capsule) [37]. The medial collateral ligament complex comprises the anterior oblique, posterior oblique, and transverse ligaments [61]. The anterior bundle of the medial collateral ligament is the primary restraint to valgus stress within functional elbow range of motion [38, 39, 61], whereas the posterior bundle is the primary restraint to valgus stress with the elbow in maximal flexion [38, 39]. The lateral ulnar collateral ligament acts as the primary stabilizer to posterolateral rotatory instability [120]. The radial head functions as an important secondary stabilizer to valgus stress, particularly in medial collateral ligament-deficient elbows [120].

Pathoanatomy of Osteoarthritis

Osteoarthritis of the elbow is characterized by osteophyte formation, capsular contracture, and loose bodies, often with relative preservation of the joint space [5]. The primary pathology is loss of articular cartilage with resulting osteophyte formation on the olecranon process, coronoid process, and their respective fossae [74]. Secondary resultant changes involve osteophyte formation along the margin of the radial head and formation of loose bodies that may result in mechanical block or crepitance [74].

Osteoarthritis typically involves the radiocapitellar joint articular cartilage preferentially, with relative preservation of the ulnohumeral articular surfaces [5]. In primary osteoarthritis, osteophytes form around the periphery of the articular surface while the central portion of the joint is usually preserved with acceptable cartilage [78]. Osteophytic change occurs predominantly in the ulnohumeral compartment, whereas joint space narrowing more frequently affects the radiocapitellar articulation [54]. Ulnohumeral osteophytes were found in 95% of patients with symptomatic elbow osteoarthritis, while radiohumeral osteophytes were found in 59% [83]. The posteromedial aspect of the radial head appears to be consistently involved in primary elbow osteoarthritis, with reciprocal changes seen on the capitellum [18].

Radiographs typically show osteophyte formation at the coronoid process (anterior and medial), coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [5, 68]. Joint spaces at the ulnohumeral joint are usually preserved or mildly narrowed in primary osteoarthritis [5, 68], while joint spaces at the radiocapitellar joint are mildly narrowed [5]. Three-dimensional computational models identify unique regions of bony impingement in elbow osteoarthritis, such as between the radial head and a posterior capitellar osteophyte in extension [55]. Normal kinematics are preserved in the osteoarthritic elbow with a normal radiocapitellar joint [23].

Posttraumatic Pathophysiology

Posttraumatic arthritis can develop in response to the initial cartilage insult or secondary to residual articular incongruities from injuries such as distal humerus fractures, radial head fractures, proximal ulna fractures, or elbow fracture-dislocations [11]. Postinjury malunions, nonunions, or residual instability can alter kinematics and load across the elbow, predisposing the joint to degenerative changes [11]. Posttraumatic arthritis may have more severe cartilage loss from the original injury and/or subsequent joint instability that results in incongruent motion and cartilage wear [78]. Posttraumatic arthritis of the elbow is frequently associated with bone loss, which makes surgical treatment difficult [11]. Radial head resection in the setting of ulnohumeral degeneration increases stress on the ulnohumeral compartment and is suggested to lead to aggravation of pre-existing degeneration [149].

Clinical Presentation

Night pain is not typical of elbow osteoarthritis; if present, an inflammatory cause should be considered [5]. Most patients initially complain of pain at terminal limits of motion as a result of capsular stretch and osteophyte impingement at the extremes of motion [74]. Later in the disease process, pain through the mid arc of motion develops as the extent of cartilage loss progresses [74]. Forearm rotation is relatively preserved until later in the disease process [5].

Classification

Radiographic Classification Systems

Broberg and Morrey: This X-ray-based system grades elbow arthrosis from 0 (normal joint) to 3 (severe degenerative change with gross destruction of the joint) [124]. The classification is based on osteophyte formation and joint space narrowing [18].

Hastings and Retting: This X-ray-based system focuses on radiocapitellar wear and subluxation [18].

Kwak et al. CT-based method: A CT-based method of quantifying elbow arthritis was described by Kwak et al. [18]. This classification demonstrated high correlation with the visual analog scale and the Mayo Elbow Performance Score, and moderate correlation with range of motion [18].

Radiographic Severity Rating: A radiographic classification system for rating the severity of primary osteoarthritis of the elbow was developed based on joint space narrowing and marginal osteophytes [27]. In a retrospective application, total elbow motion and Mayo elbow performance scores were best in patients classified as class I preoperatively and worst in those classified as class III [27]. This system is a useful tool in predicting surgical outcome following debridement of primary elbow osteoarthritis [27].

Bony Landmarks: A bony landmarks classification system effectively delineated osteophyte distribution in elbow patients [60].

Reliability and Validity

The four grades of the Broberg and Morrey classification system have only fair interobserver reliability [124]. Interobserver reliability for this system is influenced by subspecialty and experience [124]. Surgeons with more than 10 years of experience had greater agreement in arthrosis ratings than surgeons with less experience [124]. Additionally, surgeons who treated more than 10 elbow fractures per year had better agreement in arthrosis ratings than those treating fewer fractures [124]. Simplified binary rating systems for elbow arthrosis resulted in moderate agreement among observers [124].

Both the Broberg and Morrey and Hastings and Retting classification systems demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [56]. The CT-based staging system was highly reproducible compared with previous plain radiograph-based staging systems for elbow osteoarthritis [29]. It was also clinically feasible compared with previous plain radiograph-based staging systems [29].

Clinical Correlation and Outcomes

Radiologically severe osteoarthritis is related to worse clinical outcomes after arthroscopic osteocapsular arthroplasty in primary elbow osteoarthritis at medium-term follow-up [136]. Preoperative computed tomography was used to evaluate the radiologic severity of primary elbow osteoarthritis using the Kwak classification in a study of arthroscopic osteocapsular arthroplasty outcomes [136].

Clinical Presentation

Epidemiology and Demographics

Primary osteoarthritis of the elbow is relatively uncommon, affecting less than 2% of the population [18], though symptomatic primary osteoarthritis affects 2% of the population [5]. The average age of presentation is 50 years, with a range of 20 to 70 years [5]. Men are affected more often than women at a 4:1 ratio [5]. The condition predominantly affects middle-aged men undertaking heavy manual work [17], and hand dominance and strenuous manual labor are associated with primary elbow osteoarthritis [5]. In Japanese subjects aged 50-89 years, the prevalence of primary elbow osteoarthritis was 25.2%, with most cases being asymptomatic [15]. Among respondents aged 40 years or older, the prevalence of elbow osteoarthritis was 55.0%, with a symptomatic prevalence of 22.6% [25]. Older age, male sex, and a history of elbow trauma are significant risk factors for elbow osteoarthritis [25].

Pathoanatomy and Radiographic Features

Primary osteoarthritis of the elbow is unique due to relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation [19]. The primary pathology is loss of articular cartilage with resulting osteophyte formation on the olecranon process, coronoid process, and their respective fossae [74]. Secondary resultant changes involve osteophyte formation along the margin of the radial head and formation of loose bodies that may result in mechanical block or crepitance [74]. Elbow osteoarthritis typically involves the radiocapitellar joint articular cartilage preferentially, with relative preservation of the ulnohumeral articular surfaces [5]. The posteromedial aspect of the radial head appears to be consistently involved in primary elbow osteoarthritis, with reciprocal changes seen on the capitellum [18].

Radiographs typically show osteophyte formation at the coronoid process (anterior and medial), coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [5]. Joint spaces at the ulnohumeral joint are usually preserved, while those at the radiocapitellar joint are mildly narrowed [5]. Advanced elbow osteoarthritis rarely presents with joint space narrowing [5]. Periarticular hypertrophic osteophytes act as a mechanical block at the end ranges of flexion and extension [5]. Loose bodies may be evident on radiographs, which typically underestimate the number present [5]. Primary osteoarthritis of the elbow is highlighted radiographically predominantly by osteophyte formation and progresses with cartilage loss and joint space narrowing [18].

History and Symptoms

Patients with elbow osteoarthritis typically present with loss of terminal extension and flexion and painful catching, clicking, or locking of the elbow [5]. Pain is typically noted at the end ranges of motion and not through the midrange [5]. Most patients initially complain of pain at terminal limits of motion as a result of capsular stretch and osteophyte impingement at the extremes of motion, with or without mechanical symptoms [74]. Later in the disease process, pain through the mid arc of motion develops as the extent of cartilage loss progresses [74]. Night pain is not typical of elbow osteoarthritis; if present, an inflammatory cause of the arthritis should be considered [5]. Clinically, primary elbow osteoarthritis is characterized by stiffness, pain, mechanical symptoms, and weakness [18]. Primary elbow osteoarthritis presents with pain, limited movement, and potential ulnar nerve symptoms [17].

Posttraumatic arthritis of the elbow is commonly seen after distal humerus fractures, radial head fractures, proximal ulna fractures, or elbow fracture-dislocations [11]. Posttraumatic arthritis can develop in response to the initial cartilage insult or secondary to residual articular incongruities from injuries [11]. Postinjury malunions, nonunions, or residual instability can alter kinematics and load across the elbow, predisposing it to degenerative changes [11]. Posttraumatic arthritis of the elbow is particularly challenging to treat due to associated bone loss and its frequent occurrence in the younger population [11].

Physical Examination

A thorough history and physical examination are invaluable to understanding the type of disease process and the degree that the condition affects the patient [104]. Understanding whether the patient has pain throughout the arc of motion or only at terminal limits, as well as any associated mechanical symptoms or instability, is of paramount importance [104]. Associated conditions such as cubital tunnel syndrome must be considered and evaluated to provide optimal recommendations on management [104].

Inspection of the elbow should check for prior surgical incisions and joint effusion at the lateral soft spot [5]. Pain during range of motion assessment is usually felt at the end ranges of flexion and extension rather than throughout the arc [5]. Forearm rotation is relatively preserved until later in the disease process of elbow osteoarthritis [5]. Ulnar neuropathy is present in up to 50% of patients with elbow osteoarthritis [5].

Imaging

Standard AP and lateral radiographs should be obtained for the evaluation of elbow osteoarthritis [5]. Plain radiographs should be obtained during the initial workup to evaluate the articular surface and bony anatomy [104]. CT may be useful for surgical planning and allows a detailed assessment of osteophytes and the presence of loose bodies [5]. CT scans with 3D reconstructions may be useful for evaluating the extent and location of disease and for surgical planning [104]. MRI may be useful to evaluate the status of the soft tissues including the medial and lateral collateral ligamentous complexes [104]. Electromyography and nerve conduction studies (EMG/NCS) may be useful to evaluate the degree of nerve compression and contribution to the elbow pain and/or dysfunction [104].

Investigations

History and Physical Examination

Patients with elbow osteoarthritis typically present with loss of terminal extension and flexion, accompanied by painful catching, clicking, or locking [5]. Pain is characteristically noted at the end ranges of motion rather than through the midrange [5]. Night pain is not typical for this condition; if present, an inflammatory cause should be considered [5]. Primary elbow osteoarthritis predominantly affects middle-aged men undertaking heavy manual work, presenting with pain, limited movement, and potential ulnar nerve symptoms [17]. The degree of disability depends on the patient’s vocation and physical disability [5]. Physical examination includes inspection for prior surgical incisions and joint effusion at the lateral soft spot [5].

Imaging

Plain radiography: Standard AP and lateral radiographs are the initial imaging modality for evaluating elbow osteoarthritis [5]. Radiographs typically show osteophyte formation at the coronoid process, coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [5]. Joint spaces at the ulnohumeral joint are usually preserved, while those at the radiocapitellar joint are mildly narrowed [5]. On imaging assessment, signs of impingement such as osteophytes and filling of fossae are more common than cartilage lesions like joint narrowing [157].

CT: CT may be useful for surgical planning by allowing a detailed assessment of osteophytes and the presence of loose bodies [5]. CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis [148]. A CT-based staging system is highly reproducible and clinically feasible compared with plain radiograph-based staging systems [29]. A bony landmarks classification system effectively delineates osteophyte distribution in elbow patients using three-dimensional computed tomography [60].

Other Considerations: Both the Broberg and Morrey and Hasting and Retting classification systems demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [56]. Three-dimensional computational models can identify the locations and volumes of bony impingement in patients with osteoarthritis of the elbow [55]. Pre-operative simulation results can be used as an index to determine the specific osteophytes to be removed during arthroscopic surgery for elbow osteoarthritis [52].

Treatment

Non-Operative

Nonoperative treatment constitutes the first step in the early management of elbow osteoarthritis [3]. While nonsurgical treatments can be effective for reducing symptoms, they have limited effectiveness for improving range of motion limitations and pain related to impinging osteophytes [68].

Operative

Indications: Surgical treatment is indicated when conservative measures fail [44, 5]. Specific indications include loss of motion that interferes with activities of daily living, painful locking or catching of the elbow, painful end range of motion, stiffness, and the formation of bone spurs and loose bodies [5, 44]. The selection of surgical treatment must factor in the patient’s age, activity level, expectations, degree of pathologic changes, patient health, and surgeon experience [103].

Surgical Approach / Technique: Joint-sparing procedures such as débridement, excision of osteophytes, capsular release, and removal of loose bodies are preferred surgical options [5]. Arthroscopic osteocapsular arthroplasty is a safe and efficacious treatment for patients with mild to moderate osteoarthritis [2]. Arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates [13]. Arthroscopic treatment significantly improved 6-month clinical results for functional scores, pain, strength, and range of motion [43]. Both arthroscopic debridement for elbow osteoarthritis [66, 71] and osteocapsular debridement for symptomatic primary elbow osteoarthritis who have failed conservative management [45] provide satisfactory pain relief, improvement of elbow motion, and good functional outcome. Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate [65]. In a study of arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis, 87.5% of patients had functional elbow mobility at last follow-up [44]. The mean flexion/extension improvement after this procedure was 26 degrees (range 0°-40°) [44]. Clinical score improvements included a 25-point increase in MEPS and a 15-point increase in OES [44]. Patient satisfaction rates were 94% good-to-excellent [44]. Patients with either primary or posttraumatic elbow osteoarthritis can expect satisfactory elbow function and an improvement in pain with little chance of reoperation at the midterm of the follow-up duration after arthroscopic debridement [10]. A triceps tendon-guided arthroscopic olecranon debridement technique can restore adequate joint space, mobility, and function to the patient with degenerative elbow osteoarthritis [22].

Open procedures include the Outerbridge-Kashiwagi arthroplasty, the classic open procedure in which the olecranon fossa is trephinated and osteophytes are removed [5]. The medial approach is effective for the treatment of advanced primary osteoarthritis of the elbow, especially in patients with ulnar nerve symptoms as well as medial osteophytes [30]. A study evaluated outcomes at an average of ten years after débridement arthroplasties performed through a posteromedial approach for primary osteoarthritis of the elbow [21]. Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow resulted in most patients having an uneventful postoperative course with a painless elbow joint and satisfactory functional recovery at short-term follow-up [35]. A modified Outerbridge-Kashiwagi procedure combining mini-open and arthroscopic techniques achieved short-term clinical success in pain relief and function restoration in patients with elbow osteoarthritis [109].

Implant Selection: Total elbow arthroplasty is best reserved for low demand, elderly patients who will be able to comply with the 5-lb weightlifting restriction imposed postoperatively to protect the implants from bearing wear, hardware loosening, or failure [103]. Interposition arthroplasty using fascia lata graft provides favorable surgical outcomes with high satisfaction rates among young patients with elbow osteoarthritis [28]. Interposition arthroplasty is considered for intrinsic contractures in young patients (20 to 50 years) with articular cartilage destruction in whom the anatomic architecture of the distal humerus and proximal ulna are relatively preserved [72]. Elbow arthrodesis is reserved for patients with painful arthritis who are not candidates for total elbow arthroplasty, especially individuals who place high demands on the upper extremities, such as manual laborers [102]. For unilateral arthrodesis of the elbow, a position of 90 to 100 degrees of flexion is desirable to provide the most powerful grip strength [102]. Bilateral elbow arthrodesis rarely is indicated because of resultant functional limitations [102]. If bilateral elbow arthrodesis is indicated, one elbow should be placed in 110 to 120 degrees of flexion to permit the patient to reach the mouth, and the other should be placed in 45 to 65 degrees to aid in personal hygiene [102].

Other Considerations: Contraindications for arthroscopic procedures for elbow osteoarthritis include severe contracture and periarticular heterotopic ossification [5]. Relative contraindications include prior ulnar nerve transposition and prior extensive open procedures [5]. Ulnar nerve transposition and release of the posterior bundle of the medial collateral ligament (MCL) should be considered for patients who have less than 90° to 100° of elbow flexion regardless of the type of procedure used [5, 68].

Complications

Infection (PJI): Deep infections in the elbow are more common than in other joints treated arthroscopically, with a reported rate of 0.8% to 2.2% [5]. Infection can manifest as superficial minor wound complications or deep infection [5]. Intraoperative corticosteroid injections are associated with infection [5].

Nerve palsy: Transient nerve palsies complicate 1% to 3% of cases [5]. The radial and ulnar nerves are the most commonly affected by transient nerve palsies [5].

Other Considerations: Heterotopic ossification, hematoma formation, and synovial ganglion formation are recognized complications of elbow osteoarthritis treatment [5]. Survival rates for total elbow arthroplasty remain low and complication rates remain high, though they are comparable to those of other elbow arthroplasties [73]. Total elbow replacement is associated with a high complication rate and may be warranted only for seriously disabled patients [119]. Wear of the hinge mechanism is a risk during long-term follow-up of semiconstrained elbow arthroplasties [80]. Elbows treated with radial head arthroplasty presented signs of arthritis in the majority of patients after 15 years [47].

Recovery

Other Considerations: The provided evidence base does not contain specific data regarding recovery timelines, such as weeks to light activity, months to full activity, or the duration of immobilisation and rehabilitation protocols. Consequently, the standard recovery phases (Light activity, Full activity, Complete recovery / outcome plateau) and specific rehabilitation protocols are omitted from this section. The available literature focuses on long-term functional outcomes and complication rates following various surgical interventions for elbow osteoarthritis.

Arthroscopic Outcomes: Patients with either posttraumatic or primary degenerative osteoarthritis can expect satisfactory elbow function and an improvement in pain with little chance of reoperation at the midterm of the follow-up duration after arthroscopic debridement [10]. Serial assessment of patients with primary elbow osteoarthritis who underwent arthroscopic osteocapsular arthroplasty showed that clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although range of motion decreased between short- and medium-term follow-up [32].

Open Debridement and Arthroplasty Outcomes: Capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective [4]. Most patients undergoing open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow had an uneventful postoperative course and showed a painless elbow joint with satisfactory functional recovery at short-term follow-up [35]. Open arthrolysis combined with radial head arthroplasty for post-traumatic elbow stiffness yielded satisfactory short-term outcomes at 3 years, with substantial improvements in elbow mobility and function, and the results were durable over the long term (8 years) [76]. A tendency of advancing roentgenological osteoarthritic changes was recognized in most patients 10 years after the Outerbridge-Kashiwagi method for arthroplasty of osteoarthritis of the elbow [85].

Total Elbow Arthroplasty Outcomes: In most cases, elbow function was maintained in the long-term without loosening of the implant following Kudo type-5 total elbow arthroplasty for patients with rheumatoid arthritis [31]. Total elbow arthroplasty has become a reliable treatment option for elbows severely affected by rheumatoid arthritis, with recent reports showing decreased prevalence of complications, maintenance of excellent pain relief, and functional restoration [33]. The capitellocondylar total elbow replacement provided significant long-term relief of pain and improvement in functional status and range of motion in patients with rheumatoid arthritis, with improvements not deteriorating over time [126]. The capitellocondylar total elbow replacement observed favorable midterm results with good pain relief and improved function of the elbow [82]. The outcome of GSB III total elbow arthroplasty in patients with rheumatoid arthritis tends to deteriorate over time because of loosening [118]. In the course of total elbow arthroplasty, satisfactory supportive range of motion was restored to patients' elbow joints [154].

Hemiarthroplasty and Radial Head Arthroplasty Outcomes: Elbow hemiarthroplasty is an option for young or active patients with end-stage posttraumatic arthritis who are unwilling to accept activity limitations, though high rates of revision surgery and revision to total elbow arthroplasty occur [53]. After 15 years, elbows treated with radial head arthroplasty presented signs of arthritis in the majority of patients [47]. A 69-year clinical and radiologic follow-up was reported for a previously unknown radial head prosthesis [84].

Complications and Risks: Transient nerve palsies complicate 1% to 3% of cases, with radial and ulnar nerves being the most common [5].

Key Evidence

• [L4] The goal of treatment is to obtain a low level of pain with sufficient motion range to ensure good function, while preserving future surgical options and delaying elbow arthroplasty to the extent possible. [1] (10.1016/j.otsr.2013.11.004)
• [L4] Elbow AOA is a safe, efficacious treatment for patients with mild to moderate osteoarthritis. [2] (10.1016/j.jhsa.2015.11.018)
• [L5] Nonoperative treatment remains the first step in the early management of elbow osteoarthritis. [3] (10.2106/jbjs.e.00568)
• [L4] This approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow. [4] (10.1016/j.jhsa.2011.07.018)
• [L5] Treatment of posttraumatic arthritis and osteoarthritis of the elbow must be individualized on a case-by-case basis depending on location of disease, age/demand level of the patient, and stage of disease. [6] (10.1016/j.hcl.2011.02.001)
• [L4] This minimally invasive technique provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate. [7] (10.1016/j.otsr.2019.09.003)
• [L5] The appropriate treatment for elbow arthritis depends on the etiology, severity, patient age, and functional demands. [8] (10.1016/j.jhsa.2009.02.019)
• [L4] The study recommends this technique in the surgical management of patients with osteoarthritis of the elbow. [9] (10.1302/0301-620x.96b2.30714)
• [L3] Patients with either pathology can expect satisfactory elbow function and an improvement in pain with little chance of reoperation at the midterm of the follow-up duration. [10] (10.1016/j.jseint.2021.07.018)
• [L5] [11] (10.1016/j.jhsa.2022.12.014)
• [L5] Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands; nonsurgical management may provide relief in early stages, while surgical options range from arthroscopic debridement for pain at motion extremes to total elbow arthroplasty for pain throughout the arc of motion. [12] (10.1016/j.jhsa.2012.12.037)
• [L1] Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. [13] (10.1016/j.arthro.2017.08.247)
• [L5] Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age. [14] (10.1016/j.jhsa.2007.12.022)
• [L3] The prevalence of primary elbow osteoarthritis in Japanese subjects aged 50-89 years was 25.2%, with most cases being asymptomatic. [15] (10.1016/j.jse.2021.07.015)
• [L4] The OK procedure is an effective and safe way of treating both posttraumatic arthritis and osteoarthritis of the elbow. [16] (10.1016/j.jse.2015.11.052)
• [L4] Primary elbow osteoarthritis predominantly affects middle-aged men undertaking heavy manual work, presenting with pain, limited movement, and potential ulnar nerve symptoms. [17] (10.1111/j.1758-5740.2010.00089.x)
• [L3] [18] (10.1177/17585732251327183)
• [L4] Primary osteoarthritis of the elbow is unique due to relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation. [19] (10.5435/00124635-200802000-00005)
• [L4] Both open elbow debridement and the OK procedure had excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post-traumatic cases. [20] (10.1016/j.jse.2022.01.138)
• [L5] In doing so, we present a reproducible technique that can restore adequate joint space, mobility, and function to the patient with degenerative elbow osteoarthritis. [22] (10.1016/j.eats.2024.103332)
• [L4] Normal kinematics was preserved in the osteoarthritic elbow with a normal radiocapitellar joint (OAN group). [23] (10.1016/j.jhsa.2013.02.006)
• [L3] The prevalence of elbow OA was 55.0% in respondents aged 40 years or older, with a symptomatic prevalence of 22.6%; older age, male sex, and a history of elbow trauma were identified as significant risk factors. [25] (10.1016/j.jse.2018.02.049)
• [L4] [27] (10.1016/j.jse.2007.03.014)
• [L4] It provides favorable surgical outcomes with high satisfaction rates among young patients with elbow osteoarthritis. [28] (10.1016/j.jhsg.2024.05.002)
• [L4] CT-based staging system was highly reproducible and clinically feasible, compared with previous plain radiograph-based staging systems, for elbow osteoarthritis. [29] (10.1016/j.joca.2019.03.004)
• [L4] The medial approach is effective for the treatment of advanced primary osteoarthritis of the elbow, especially in patients with ulnar nerve symptoms as well as medial osteophytes. [30] (10.2106/jbjs.d.02684)
• [L3] In most cases, elbow function was maintained in the long-term without loosening of the implant. [31] (10.1302/0301-620x.99b6.bjj-2016-1033.r2)
• [L4] Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA showed that the clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although ROM decreased between short- and medium-term follow-up. [32] (10.1177/23259671231162398)
• [L4] Total elbow arthroplasty has become a reliable treatment option for elbows severely affected by rheumatoid arthritis, with recent reports showing decreased prevalence of complications, maintenance of excellent pain relief, and functional restoration. [33] (10.2106/00004623-199805000-00008)
• [L4] Most patients had an uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional recovery at short-term follow-up. [35] (10.1016/j.jse.2011.08.071)
• [L4] Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. [41] (10.1016/j.jse.2019.09.036)
• [L4] Total elbow arthroplasty remains associated with substantial complication and reoperation rates. [42] (10.1016/j.jhsg.2026.100981)
• [L3] Arthroscopic treatment of elbow osteoarthritis significantly improved 6-month clinical results for functional scores, pain, strength and range of motion. [43] (10.1016/j.otsr.2019.09.002)
• [L4] [44] (10.1007/s12306-015-0365-0)
• [L2] Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management. [45] (10.1016/j.jse.2020.01.060)
• [L4] After 15 years, elbows treated with RHA presented signs of arthritis in the majority of patients. [47] (10.1016/j.jse.2025.06.026)
• [L4] These results can be used as an index to determine the osteophytes to be removed during arthroscopic surgery for elbow osteoarthritis. [52] (10.1016/j.jseint.2026.101667)
• [L4] Elbow hemiarthroplasty is an option for young or active patients with end-stage posttraumatic arthritis who are unwilling to accept activity limitations, though high rates of revision surgery and revision to total elbow arthroplasty occur. [53] (10.5435/jaaos-d-18-00055)
• [L3] Osteophytic change occurs predominantly in the ulnohumeral compartment of the elbow, whereas joint space narrowing more frequently affects the radiocapitellar articulation. [54] (10.1016/j.jse.2006.08.005)
• [L4] Three-dimensional computational models identified the locations and volumes of bony impingement in patients with osteoarthritis of the elbow and highlighted unique regions of impingement, such as between the radial head and a posterior capitellar osteophyte in extension. [55] (10.1016/j.jhsa.2013.03.035)
• [L3] Both the BM and HR classification systems demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow. [56] (10.1016/j.jse.2014.10.015)
• [L3] The bony landmarks classification system effectively delineated osteophyte distribution in elbow patients. [60] (10.1186/s13018-025-06145-9)
• [L5] However, from the data we obtained the open and arthroscopic debridement procedures seem to be safe and effective in the treatment of elbow OA. [63] (10.1186/s12891-018-2318-x)
• [L1] Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate. [65] (10.1302/2058-5241.5.190095)
• [L4] Arthroscopic debridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. [66] (10.1016/j.jse.2014.01.009)
• [L4] Arthroscopic debridement for the elbow osteoarthritis provided satisfactory pain relief, improvement of elbow motion, and good functional outcome. [71] (10.1016/s0363-5023(11)60056-7)
• [L4] Survival rates nonetheless remain low and complication rates remain high yet are comparable to those of other elbow arthroplasties. [73] (10.1016/j.jse.2021.08.028)
• [L4] OEA with RHA yielded satisfactory short-term outcomes for PTES at 3 years, with substantial improvements in elbow mobility and function, and the results were durable over the long term (8 years). [76] (10.1016/j.jse.2021.10.028)
• [L5] [78] (10.1016/j.hcl.2020.07.009)
• [L4] Surgical options must be tailored to cartilage integrity and bone structure, with total elbow arthroplasty generally avoided in young, active patients due to poor durability. [79] (10.1016/j.jhsg.2025.100736)
• [Case_report] Long-term survival of semiconstrained elbow arthroplasties is favorable, but wear of the hinge mechanism is a risk during follow-up. [80] (10.1016/j.otsr.2014.07.013)
• [L4] The study observed favorable midterm results with the capitellocondylar total elbow replacement, with good pain relief and improved function of the elbow. [82] (10.1016/j.jse.2004.10.010)
• [L4] [83] (10.1016/j.jse.2008.03.012)
• [L4] We have reported a 69-year clinical and radiologic follow-up of a previously unknown radial head prosthesis. [84] (10.1016/j.jse.2014.09.030)
• [L4] However, a tendency of advancing roentgenological osteoarthritic changes was recognized in most patients 10 years after OKM. [85] (10.1007/bf01234111)
• [L4] The modified Outerbridge-Kashiwagi procedure combining mini-open and arthroscopic techniques achieved short-term clinical success in pain relief and function restoration in patients with elbow osteoarthritis. [109] (10.1016/j.jse.2020.05.007)
• [L3] Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. [110] (10.1016/j.arthro.2018.11.057)
• [L4] However, the outcome tends to deteriorate over time because of loosening, and further follow-up is required to analyze long-term loosening rates. [118] (10.1007/s10165-011-0509-5)
• [L3] Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. [119] (10.2106/jbjs.d.02734)
• [L3] [124] (10.1016/j.jhsa.2011.12.043)
• [L3] The capitellocondylar total elbow replacement provided significant long-term relief of pain and improvement in functional status and range of motion in patients with rheumatoid arthritis, with improvements not deteriorating over time. [126] (10.2106/00004623-199304000-00004)
• [L3] [136] (10.1016/j.jse.2023.05.041)
• [L1] CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. [148] (10.1016/j.jse.2021.04.001)
• [L5] [149] (10.1007/s00167-015-3518-7)
• [L4] In the course of total elbow arthroplasty, satisfactory supportive range of motion was restored to patients' elbow joints. [154] (10.1136/annrheumdis-2014-eular.2916)
• [L3] On the imaging assessment, signs of impingement (osteophytes and filling of fossae) are more common than cartilage lesions (joint narrowing). [157] (10.1016/j.otsr.2019.09.012)

See Also

• Elbow Arthroplasty
• Cubital Tunnel Syndrome
• Radial head arthroplasty

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