Elbow surgery can be challenging, not only because the elbow is a relatively small and complex hinge joint, but also because next-generation arthritis drugs have created healthier patients who need longer lasting, more durable treatments, including implants.

Connected by three long bones – the humerus in the upper arm and the ulna and radius in the forearm ­­– the elbow positions the hand properly in space, so a pain-free, stable elbow is essential for most daily activities. Surgical options are only considered when medications and other measures don't relieve severe pain and loss of motion. Here are insights into the most common types of elbow surgeries.

Synovectomy

This procedure removes the synovium – the soft membrane lining the joint. In a healthy elbow, the synovium produces a lubricating fluid that eliminates friction as the arm moves. But in rheumatoid arthritis (RA) and other forms of inflammatory arthritis, the synovium becomes inflamed, eventually eroding cartilage and causing pain and swelling. Removing the synovium temporarily stops this destructive process. Synovectomy can be performed arthroscopically, using small incisions and fiberoptic (camera) technology, or as a conventional open procedure. Recovery time depends on whether the procedure was performed arthroscopically or conventionally, and on the amount of tissue damage. Rehabilitation takes a minimum of two months.

Best candidates are patients in the early stages of inflammatory types of arthritis (like RA) with little or no cartilage damage.

Pros – Synovectomy can improve symptoms significantly, says Robert N. Hotchkiss, MD, director of research in the hand and upper extremity service at Hospital for Special Surgery in New York City. "Performance and pain scores improve, swelling goes down and many [patients] return to near-normal function." Arthroscopic synovectomy usually results in a faster, less painful recovery.

Cons – Synovectomy doesn't stop disease progression. After several years, the synovium starts to regrow and symptoms usually return. (The surgery can be repeated). In addition, nerve injury is a significant risk in arthroscopic elbow procedures because the tight space is difficult to navigate and major nerves are close to the joint.

Arthroscopic debridement

This technique removes bony growths in the joint along with any loose bits of bone or cartilage. In some cases, the upper end or head of the radius is also removed. Although no longer recommended for knee osteoarthritis (OA), debridement is successfully used for posttraumatic and primary OA in the elbow. Like synovectomy, it can be performed arthroscopically or as an open procedure. Recovery time – between 12 and 24 weeks (including rehabilitation) – depends on whether the procedure was performed arthroscopically or conventionally, the age of the patient and what was done (for example, if the head of the radius is removed, the recovery period will be longer).

Best candidates are patients with mild to moderate OA who have stiffness and minor pain. Those with pain throughout their full range of motion or advanced disease are not good candidates, according to Robert Wysocki, MD, a hand, wrist and elbow surgeon and assistant professor at Rush University Medical Center in Chicago.

Pros – Most people experience 80 to 95 percent pain relief and increased range of motion after the procedure. Open and arthroscopic procedures have equally successful outcomes, but arthroscopic techniques, which have improved considerably in the past decade, are associated with faster healing and less pain.

Cons – Boney growths tend to recur and range of motion decreases over time, although many people continue to experience significant pain relief. Like arthroscopic synovectomy, arthroscopic debridement "carries a risk of nerve injury for even the highly trained elbow arthroscopist," Dr. Wysocki says.