Surgical medical intervention aimed at treating elbow stiffness

What is osteocapsuloplasty?

Osteocapsuloplasty, also known as arthroscopic osteocapsular arthroplasty, is a surgical medical intervention aimed at treating elbow stiffness. Occasionally, elbow stiffness is also accompanied by elbow impingement, which if left untreated, could lead to loss of motion. The fundamental goal of osteocapsuloplasty is to recover mobility and address deformities of the elbow joint. 

Arguably one of most complex elbow arthroscopy surgeries, osteocapsuloplasty involves:

  • Soft tissue and bony debridement: involves removing damaged articular cartilage and tendon at the elbow.
  • Osteophyte and loose body removal: osteophyte and loose body removal involves removing bone spurs (growth on the bone) and small fragments of bones, tissues, and cartilage that chip off in the joint.
  • Synovectomy: removal of inflamed joint tissues known as synovium
  • Bony contouring: reshaping the humerus and/or ulna such as a radial head excision (removing radial head).
elbow arthroscopy
Elbow arthroscopy is a minimally invasive surgical procedure.

When symptoms have progressed and cause significant interruption in quality of life, it is important that osteocapsuloplasty is performed. 

Some symptoms to look out for include:

  • Elbow “locking” up which indicates loose bodies present at the hinge of the joint
  • Decreased range of motion 
  • Pain ranging from chronic to intermittent occurrences
  • Grinding of the elbow joint
  • Swelling 

How does osteocapsuloplasty work?

During the surgery, three or four small incisions are made at the elbow; if large 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.

Upon identifying the issues at the elbow joint, capsuloplasty will be executed. This fundamentally involves debridement of the elbow joint to restore function. At this stage, the damaged tendon and cartilage will be removed. This process is also known as resection. Additionally, bone spurs will be scraped off the bone along with any loose bodies found floating at the elbow joint.  

Finally, bones will be contoured or reshaped until the normal shape has been restored. The surgical site is then irrigated to prevent infections before it is closed either by suture or staples. 

It is important to note that an osteocapsuloplasty procedure will not be the same for every patient. The approach taken will differ based on the cause of stiffness and the specific bones that are affected. Additionally, the method employed will also differ based on the severity of the joint condition and the levels of degeneration that are identified. 

Benefits of osteocapsuloplasty

  • Minimally invasive
  • Quicker discharge 
  • Minimal scarring 
  • Short recovery period 

What conditions can osteocapsuloplasty treat?

Osteocapsuloplasty can be used to treat the following conditions:
  • Arthritis: arthritis such as elbow osteoarthritis can be treated with an osteocapsuloplasty. 
  • Fractures: elbow fractures can cause bits of bones or cartilage to break away and calcify at the joint. 
  • Joint inflammation: injuries and inflammatory arthritis are common causes of joint inflammation and is 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 that occurs when the cartilage or bone near the growth plate overgrows.
  • Post-traumatic extrinsic stiffness: a functional impairment of the elbow joint following an injury.
  • Melorheostosis: a rare bone disorder in which new bone tissues grow on existing bones. 
elbow fracture
Elbow fractures can be treated with an osteocapsuloplasty.

What results can I expect?

Osteocapsuloplasties are often conducted as a secondary surgery (surgery performed after the initial surgical procedure). Upon administration of surgery and subsequent recovery, one can expect an improved range of motion and elbow function. 

Recovery may take anywhere between 4 weeks to 6 months. The recovery period also depends on the bones which were treated, the number of growths, and the volume of debridement. 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, the deformities and abnormal growth at the elbow joint are addressed within one session. However, there are cases where repeated surgeries are required. Multiple surgeries might be necessary to remove newly formed growths and loose bodies or those which were evasive in former surgeries. 

Osteocapsuloplasty is a complicated surgery which involves multiple procedures to address a variety of abnormalities found at the joint. Each type of growth would require a different technique. On top of that a variety of techniques would need to be employed to reshape the bone back into a functional form. This is especially true if faultiness in surgical methods from previous elbow injuries is evident. 

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.

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