Elbow Care History

The Evolution of Elbow Surgery and Arthritis Management

Elbow surgery has undergone remarkable transformations over the last century, driven by groundbreaking innovations in trauma care, inflammatory arthritis treatment, primary osteoarthritis management, and infection control. Below is a timeline of the major advancements that have shaped how surgeons approach elbow conditions today.

Click Here to Watch a Video from Dr. Morrey on the history of Elbow Surgery

Traumatic Arthritis

Early Approaches (Pre-1920)

Limited treatment options, primarily resection to remove damaged bone.

1920s-1940s: Expanding Surgical Techniques

1920 – Chilectomy, a procedure to remove bone spurs and improve mobility.
Immobilization and the “bag of bones” approach were common strategies.
Surgeons explored fusion, joint resection, and open debridement to stabilize the elbow.

Mid-20th Century: Innovations in Joint Preservation

1940 – Interposition arthroplasty, cushioning the joint using soft tissue or synthetic materials.
1947 – Introduction of DMARDs (Disease-Modifying Antirheumatic Drugs) to slow disease progression.

1970s-Present: Modern Surgical Solutions

1970 – Arthroscopic debridement, a minimally invasive technique for joint repair.
Partial and total elbow replacement for severe joint damage.

Inflammatory Arthritis

Early Approaches (Pre-1920)

Treatment options were very limited, relying on pain medication and resection.

1920s-1940s: Foundational Techniques

1920 – Chilectomy introduced for removing bone spurs.
Immobilization, joint fusion, and resection were common strategies.

1940s-1970s: Advancements in Arthritis Care

1947 – DMARDs revolutionized treatment for inflammatory arthritis.
Open debridement and synovectomy helped remove inflamed tissue.
Interposition arthroplasty emerged as a promising solution.

1970s-Present: Modern Treatments

1970 – Arthroscopic debridement became a preferred minimally invasive option.
Partial and total elbow replacement offered new solutions for severe cases.

Primary Osteoarthritis

1970s: Defining the Pathology

Researchers clarified that primary osteoarthritis is a “marginal” disease, affecting the articular margin rather than the entire joint.
Osteophytes (bone spurs) were identified as the dominant pathology.

Preferred Treatment Approach

Debridement became the treatment of choice, effectively removing osteophytes.
Joint replacement was found to be rarely indicated since damage was primarily at the margins.
Interposition arthroplasty became the preferred option when debridement failed.

Sepsis Management

Pre-1940s: Lethal Consequences

1920s – Sepsis was often fatal, with distorted joint function and no viable treatments beyond resection, amputation, and fusion.

1940s: The Dawn of Modern Infection Control

1940 – The introduction of penicillin launched modern sepsis management.
Efforts shifted toward salvaging function, using limited resection and debridement.
Improved anesthesia and the introduction of spectrum antibiotics expanded treatment possibilities.

2010-Present: Revolutionary Techniques

2010 – Advanced Prosthetic Constructs (APC) utilizing 3D printing began restoring function.
Post-2010, APC evolved into a primary management strategy, reshaping how elbow infections are treated.

Conclusion

The field of elbow surgery has witnessed dramatic advancements across trauma, inflammatory arthritis, osteoarthritis, and sepsis treatment. With innovations in arthroscopy, joint preservation, prosthetic technologies, and medical therapies, surgeons now have a wide array of solutions to restore elbow function and improve patients' quality of life.