Loose body removal on the elbow is one of the most commonly conducted arthroscopic procedures. Loose bodies are small fragments of bones, tissues, and cartilage that chip off in the joint and are particularly evasive in imaging tests.
There are multiple reasons why loose bodies are found floating in the joint:
Underlying health conditions that cause degeneration of the elbow joint
Prior injuries that cause fragmentation of the bone or cartilage
Repeated stress to the joint from specific activities or sports
Loose bodies in elbow joints can be particularly uncomfortable and mentally taxing as some patients can feel “the sensation of foreign particles” in their joints. However, there are cases in which the presence of loose bodies is asymptomatic in some patients. In such cases, this condition goes untreated and may not pose significant trouble (conservative measures should still be taken to prevent future complications).
When symptoms have progressed and cause significant interruption in quality of life, it is important that arthroscopy is performed to remove loose bodies.
Some of the symptoms to look out for include:
Elbow “locking” up which indicates presence of loose bodies at the hinge of the joint
Decreased range of motion
Pain ranging from chronic to intermittent
Grinding of the elbow joint
How does loose body removal work?
During the surgery, three or four small incisions are made at the elbow. Where larger loose bodies are present, a larger incision may be necessary. An arthroscope is then inserted, allowing your surgeon to visually assess the condition of your elbow through the camera. This phase of the procedure is also known as arthroscopic diagnosis.
The surgeon then attempts to identify the location of the loose bodies, in the anterior and posterior areas of the elbow joint. The identified loose bodies are subsequently extracted using a suction cup. If there are any other injuries that have been identified during the arthroscopic diagnosis, these will also be addressed. This is especially applicable if the injury or identified condition of the joint is causing the presence of loose bodies. The surgical site is then irrigated to prevent infections before it is closed either by suture or staples.
Benefits of loose body removal
Short recovery period
What conditions can loose body removal treat?
Loose body removal can be used to treat the following conditions:
Fractures:fractures can cause bits of bones or cartilage to break away. Hence, loose body removal will help to remove them.
Osteochondritis dissecans: also known as OCD, is a condition that most commonly develops in the joints of children and adolescents. It occurs when a piece of bone separates due to loss of blood supply.
Joint inflammation: injuries and inflammatory arthritis are common causes of joint inflammation, characterised by pain and swelling.
Synovial chondromatosis: a rare condition that occurs when the synovial has benign or non-cancerous growths or nodules made of cartilage.
Osteochondromas: the most common bone growth condition that occurs when the cartilage or bone near the growth plate overgrows.
What results can I expect?
Removal of loose bodies stands to have one of the highest success rates at 89%. These arthroscopic interventions are often conducted as a secondary surgery (surgery performed after the initial surgical procedure). Upon loose body removal treatment, one can observe dramatic improvement in the quality of life accompanied by psychological and pain relief. Additionally, loose body removal will also recover joint mobility and function.
Recovery could take anywhere between 4 weeks to 6 months. If other injuries are involved in the joint, the duration of recovery could last longer. The recovery period also depends on the volume of loose bodies present and the damage incurred.
Discipline and dedication towards physiotherapy would help in speeding up recovery. Diets and post-surgical habits could also impact your healing rate. With positive post-surgical care and collaborative work with your orthopaedist, a positive outcome can be anticipated.
Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.
How many treatment sessions are needed?
Ideally, your surgeon would attempt to identify and remove loose bodies within one session. However, there are cases where repeated surgeries are required. Some factors may be continued degeneration of elbow joints, and an increase in loose body presence. Multiple surgeries may be necessary to remove newly formed loose bodies or loose bodies which were evasive in former surgeries.
Loose body removal is a complicated surgery by comparison. Occasionally loose bodies identified in imaging may simply disappear when arthroscopy is conducted. This is especially true if faultiness in surgical methods from previous elbow injuries is evident.
Your orthopaedist will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.
Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.
Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.