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This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Nonoperative treatment remains the first step in the early management of elbow osteoarthritis [1].
• Total elbow arthroplasty is a reliable treatment option for elbows severely affected by rheumatoid arthritis, with decreased prevalence of complications, maintenance of excellent pain relief, and functional restoration [17].
• Total elbow arthroplasty is generally avoided in young, active patients due to poor durability [33].
• Surgical options for severe elbow arthritis must be tailored to cartilage integrity and bone structure [33].
• Open capsulectomy and debridement through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow [2].
• Elbow arthroscopic osteocapsular arthroplasty is a safe and efficacious treatment for patients with mild to moderate osteoarthritis [3].
• Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis [25].
• Arthroscopic debridement provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate [4].
• 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 [14].
• Computer simulation studies recommend arthroscopic debridement in the surgical management of patients with osteoarthritis of the elbow [6].
• Both open elbow debridement and the Outerbridge-Kashiwagi (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 [11].
• The Outerbridge-Kashiwagi procedure is an effective and safe way of treating both posttraumatic arthritis and osteoarthritis of the elbow [12].
• Open and arthroscopic debridement procedures are safe and effective in the treatment of elbow osteoarthritis [21].

Anatomy & Pathophysiology

• Osteophytic change in primary elbow osteoarthritis occurs predominantly in the ulnohumeral compartment [45].
• Joint space narrowing in primary elbow osteoarthritis more frequently affects the radiocapitellar articulation [45].
• 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 [35].
• The combination of shoulder, elbow, and knee joint involvement accounts for approximately 70% of the contribution to all variables in the assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set [43].
• The addition of wrist and ankle joints to the assessment of rheumatoid arthritis increases the contribution to all variables to approximately 90% [43].

Classification

• The BM classification system demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [20].
• The HR classification system demonstrated substantial intraobserver and interobserver reliability for evaluating radiographic severity of post-traumatic arthritis and primary osteoarthritis of the elbow [20].
• The CT-based staging system for primary elbow osteoarthritis was highly reproducible and clinically feasible compared with previous plain radiograph-based staging systems [22].
• The bony landmarks classification system effectively delineated osteophyte distribution in elbow osteoarthritis patients [36].
• Both the Larsen and Sharp classifications can reliably be used to evaluate rheumatoid arthritis of the elbow by observers of varying training levels [42].

Clinical Presentation

• Post-traumatic osteoarthritis of the elbow is an uncommon condition where clinical manifestations often vary from radiological findings [5].
• Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age [7].
• The prevalence of primary elbow osteoarthritis in Japanese subjects aged 50-89 years was 25.2%, with most cases being asymptomatic [8].
• The purpose of the review includes discussing the principles of diagnosis and evaluation for elbow arthritis [9].
• 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 [10].
• The appropriate treatment for elbow arthritis depends on the etiology, severity, patient age, and functional demands [13].
• 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 [15].
• Male patients with primary elbow osteoarthritis had cartilage loss predominantly in the radiocapitellar articulation [18].
• Female patients with primary elbow osteoarthritis had similar radiocapitellar and ulnohumeral joint involvement, suggesting more symmetric cartilage wear [18].
• The prevalence of elbow OA was 55.0% in respondents aged 40 years or older, with a symptomatic prevalence of 22.6% [23].
• Older age, male sex, and a history of elbow trauma were identified as significant risk factors for elbow OA [23].
• Treatment of elbow arthritis must be individualized based on etiology, severity, patient age, and functional demands [24].
• Nonsurgical management may provide relief in early stages of elbow arthritis [24].
• Surgical options for elbow arthritis range from arthroscopic debridement for pain at motion extremes to total elbow arthroplasty for pain throughout the arc of motion [24].
• Primary osteoarthritis of the elbow is unique due to relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation [26].
• Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management [28].
• When both the shoulder and elbow are involved, the joint that causes the most pain and disability should be operated on first [30].
• Arthroscopic osteophyte resection and capsulectomy addresses the pathologic processes associated with arthritis of the elbow and was safe and effective [31].

Investigations

• Male patients with primary elbow osteoarthritis had cartilage loss predominantly in the radiocapitellar articulation, while female patients had similar radiocapitellar and ulnohumeral joint involvement suggesting more symmetric cartilage wear [18].
• 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 [20].
• CT-based staging system was highly reproducible and clinically feasible, compared with previous plain radiograph-based staging systems, for elbow osteoarthritis [22].
• CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis [49].

Treatment

• Nonoperative treatment is the first step in the early management of elbow osteoarthritis [1].
• Capsulectomy and debridement through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow [2].
• Elbow arthroscopic osteocapsular arthroplasty (AOA) is a safe, efficacious treatment for patients with mild to moderate osteoarthritis [3].
• Arthroscopic treatment of elbow osteoarthritis provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate [4].
• Arthroscopic debridement is recommended in the surgical management of patients with osteoarthritis of the elbow based on computer simulation [6].
• Both open elbow debridement and the Outerbridge-Kashiwagi (OK) procedure had excellent survivorship until conversion to total elbow arthroplasty [11].
• Open elbow debridement and the OK procedure are viable options in the treatment of primary elbow osteoarthritis and post-traumatic cases [11].
• The OK procedure is an effective and safe way of treating both posttraumatic arthritis and osteoarthritis of the elbow [12].
• Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes [14].
• Elbow arthroscopic debridement for primary degenerative osteoarthritis is associated with low complication and reoperation rates [14].
• Open and arthroscopic debridement procedures seem to be safe and effective in the treatment of elbow OA [21].
• Arthroscopic treatment of elbow osteoarthritis significantly improved 6-month clinical results for functional scores, pain, strength and range of motion [38].
• Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate [39].
• Arthroscopic debridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome [40].

Complications

• Surgical treatment for elbow arthritis is associated with a low rate of complications when performed via a medial trans-flexor approach for capsulectomy and debridement in primary osteoarthritis [2].
• Elbow arthroscopic osteocapsular arthroplasty (AOA) is considered a safe treatment for patients with mild to moderate osteoarthritis [3].
• Arthroscopic treatment of elbow osteoarthritis is associated with a low complication rate [4].
• Elbow arthroscopic debridement for primary degenerative osteoarthritis results in low complication and reoperation rates [14].
• Total elbow arthroplasty remains associated with substantial complication and reoperation rates [37].

Recovery

• Capsulectomy and debridement through a medial trans-flexor approach is associated with a low rate of complications and is safe and effective for primary osteoarthritis of the elbow [2].
• Elbow arthroscopic osteocapsular arthroplasty (AOA) is a safe and efficacious treatment for patients with mild to moderate osteoarthritis [3].
• 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 follow-up duration after arthroscopic elbow debridement [10].
• Both open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options for primary elbow osteoarthritis and post-traumatic cases [11].
• Serial assessment of patients with primary elbow OA who underwent arthroscopic osteocapsular arthroplasty (OCA) showed that clinical outcomes improved from preoperative assessment to short- and medium-term follow-up [27].
• Range of motion (ROM) decreased between short- and medium-term follow-up in patients with primary elbow OA who underwent arthroscopic OCA [27].
• Most patients undergoing open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow had an uneventful postoperative course, a painless elbow joint, and satisfactory functional recovery at short-term follow-up [32].
• In most cases, elbow function was maintained in the long-term without loosening of the implant in patients with rheumatoid arthritis treated with Kudo type-5 total elbow arthroplasty [16].
• Long-term follow-up showed acceptable results of the type-3 Kudo total elbow arthroplasty in patients with rheumatoid arthritis [29].
• The outcome of GSB III total elbow arthroplasty in patients with rheumatoid arthritis tends to deteriorate over time because of loosening [44].
• Total elbow arthroplasty restored satisfactory supportive range of motion to patients' elbow joints in the course of treatment for rheumatoid arthritis [51].

Key Evidence

• [L5] Nonoperative treatment remains the first step in the early management of elbow osteoarthritis. [1] (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. [2] (10.1016/j.jhsa.2011.07.018)
• [L4] Elbow AOA is a safe, efficacious treatment for patients with mild to moderate osteoarthritis. [3] (10.1016/j.jhsa.2015.11.018)
• [L4] This minimally invasive technique provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate. [4] (10.1016/j.otsr.2019.09.003)
• [L4] Post-traumatic osteoarthritis of the elbow is an uncommon condition where clinical manifestations often vary from radiological findings. [5] (10.1016/j.otsr.2013.11.004)
• [L4] The study recommends this technique in the surgical management of patients with osteoarthritis of the elbow. [6] (10.1302/0301-620x.96b2.30714)
• [L5] Surgical treatment for elbow arthritis is based on disease etiology, severity of degeneration, and patient age. [7] (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. [8] (10.1016/j.jse.2021.07.015)
• [L5] The purpose of this article is to review the pertinent soft tissue and osseous anatomy, discuss the etiologies, review the principles of diagnosis and evaluation, and finally, study the treatment options for elbow arthritis. [9] (10.1016/j.jhsa.2022.12.014)
• [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)
• [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. [11] (10.1016/j.jse.2022.01.138)
• [L4] The OK procedure is an effective and safe way of treating both posttraumatic arthritis and osteoarthritis of the elbow. [12] (10.1016/j.jse.2015.11.052)
• [L5] The appropriate treatment for elbow arthritis depends on the etiology, severity, patient age, and functional demands. [13] (10.1016/j.jhsa.2009.02.019)
• [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. [14] (10.1016/j.arthro.2017.08.247)
• [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. [15] (10.2106/jbjs.d.02684)
• [L3] In most cases, elbow function was maintained in the long-term without loosening of the implant. [16] (10.1302/0301-620x.99b6.bjj-2016-1033.r2)
• [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. [17] (10.2106/00004623-199805000-00008)
• [L3] Male patients with primary elbow osteoarthritis had cartilage loss predominantly in the radiocapitellar articulation, while female patients had similar radiocapitellar and ulnohumeral joint involvement suggesting more symmetric cartilage wear. [18] (10.1177/17585732251327183)
• [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. [20] (10.1016/j.jse.2014.10.015)
• [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. [21] (10.1186/s12891-018-2318-x)
• [L4] CT-based staging system was highly reproducible and clinically feasible, compared with previous plain radiograph-based staging systems, for elbow osteoarthritis. [22] (10.1016/j.joca.2019.03.004)
• [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. [23] (10.1016/j.jse.2018.02.049)
• [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. [24] (10.1016/j.jhsa.2012.12.037)
• [L4] Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. [25] (10.1016/j.jse.2019.09.036)
• [L4] Primary osteoarthritis of the elbow is unique due to relative preservation of articular cartilage and maintenance of joint space with hypertrophic osteophyte formation. [26] (10.5435/00124635-200802000-00005)
• [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. [27] (10.1177/23259671231162398)
• [L2] Osteocapsular debridement is an effective surgical treatment option for patients with symptomatic primary elbow osteoarthritis who have failed conservative management. [28] (10.1016/j.jse.2020.01.060)
• [L3] This long-term follow-up study showed acceptable results of the type-3 Kudo total elbow arthroplasty in patients with rheumatoid arthritis. [29] (10.2106/00004623-200110000-00008)
• [L4] When both the shoulder and elbow are involved, the joint that causes the most pain and disability should be operated on first. [30] (10.2106/00004623-198870010-00031)
• [L4] This procedure addresses the pathologic processes associated with arthritis of the elbow and was safe and effective in this series. [31] (10.1016/j.jse.2007.04.005)
• [L4] Most patients had an uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional recovery at short-term follow-up. [32] (10.1016/j.jse.2011.08.071)
• [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. [33] (10.1016/j.jhsg.2025.100736)
• [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. [35] (10.1016/j.jhsa.2013.03.035)
• [L3] The bony landmarks classification system effectively delineated osteophyte distribution in elbow patients. [36] (10.1186/s13018-025-06145-9)
• [L4] Total elbow arthroplasty remains associated with substantial complication and reoperation rates. [37] (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. [38] (10.1016/j.otsr.2019.09.002)
• [L1] Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate. [39] (10.1302/2058-5241.5.190095)
• [L4] Arthroscopic debridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. [40] (10.1016/j.jse.2014.01.009)
• [L4] Both systems can reliably be used to evaluate rheumatoid arthritis of the elbow by observers of varying training levels. [42] (10.1016/j.jse.2016.07.074)
• [L4] The combination of shoulder, elbow, and knee joints accounted for approximately 70% of the contribution to all the variables, while addition of the wrist and ankle joints increased this value to approximately 90%. [43] (10.1002/art.21589)
• [L4] However, the outcome tends to deteriorate over time because of loosening, and further follow-up is required to analyze long-term loosening rates. [44] (10.1007/s10165-011-0509-5)
• [L3] Osteophytic change occurs predominantly in the ulnohumeral compartment of the elbow, whereas joint space narrowing more frequently affects the radiocapitellar articulation. [45] (10.1016/j.jse.2006.08.005)
• [L1] CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. [49] (10.1016/j.jse.2021.04.001)
• [L4] In the course of total elbow arthroplasty, satisfactory supportive range of motion was restored to patients' elbow joints. [51] (10.1136/annrheumdis-2014-eular.2916)

References

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[17] Total Elbow Arthroplasty in Patients Who Have Juvenile Rheumatoid Arthritis. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199805000-00008

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[22] Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment. Osteoarthritis and Cartilage. 2019. DOI: 10.1016/j.joca.2019.03.004

[23] The prevalence of elbow osteoarthritis in Japanese middle-aged and elderly populations: the relationship between risk factors and function. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.049

[24] Elbow Arthritis: Current Concepts. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.12.037

[25] Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography–based classification. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.036

[26] Primary Osteoarthritis of the Elbow: Current Treatment Options. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200802000-00005

[27] Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231162398

[28] The Clinical Impact of Different Approaches to Osteocapsular Debridement for Primary Osteoarthritis of the Elbow: A Systematic Review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.060

[29] Kudo Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200110000-00008

[30] Arthroplasty of the ipsilateral shoulder and elbow in patients who have rheumatoid arthritis.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870010-00031

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[32] Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow: a multicenter study. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.08.071

[33] Management of Severe Elbow Arthritis in a Young Patient. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100736

[35] Identifying the Location and Volume of Bony Impingement in Elbow Osteoarthritis by 3-Dimensional Computational Modeling. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.035

[36] Bony landmarks guided mapping of the osteophytes of the elbow osteoarthritis patients: a three dimensional computed tomograph based study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06145-9

[37] Total Elbow Arthroplasty Complication, Reoperation, and Revision Rates: A Comparison Between Arthroplasty for Arthritis Versus Fracture. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100981

[38] Arthroscopic debridement for osteoarthritis of the elbow: Results and analysis of predictive factors. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.09.002

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[40] Arthroscopic débridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.009

[42] Reliability testing of the Larsen and Sharp classifications for rheumatoid arthritis of the elbow. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.07.074

[43] Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set. Arthritis Care & Research. 2005. DOI: 10.1002/art.21589

[44] Clinical and radiological results of GSB III total elbow arthroplasty in patients with rheumatoid arthritis. Modern Rheumatology. 2011. DOI: 10.1007/s10165-011-0509-5

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[51] AB0306 Does Total Elbow Arthroplasty Improve Disease Activity Scores and HAQ in Patients with Rheumatoid Arthritis Treated with Biologics?. Annals of the Rheumatic Diseases. 2014. DOI: 10.1136/annrheumdis-2014-eular.2916