Staged Bilateral Total Elbow Arthroplasty in Advanced Rheumatoid Elbow Disease: A Case Report.

INTRODUCTION

Total elbow arthroplasty (TEA) remains a valuable surgical option for end-stage rheumatoid elbow disease, particularly in elderly, low-demand patients with painful joint destruction and functional loss. Bilateral elbow involvement can severely compromise self-care and independence, and staged bilateral TEA requires careful patient selection and realistic counseling.

CASE REPORT: We report a 79-year-old female with long-standing rheumatoid arthritis, hypertension, and glaucoma, with a relevant surgical history that included right total hip arthroplasty, bilateral total knee arthroplasty, bilateral hallux valgus correction, cataract surgery, and bilateral carpal tunnel release. She was referred to the orthopedic clinic in May 2018 with severe bilateral elbow pain, worse on the right side, progressive loss of motion, and declining autonomy. Imaging showed advanced articular destruction and a reducible dislocation of the right elbow. There were no ulnar nerve symptoms or distal neurovascular deficits. After clinical and radiological assessment and departmental discussion, right TEA was performed in December 2019, with marked pain relief and functional improvement. Due to progression of contralateral disease, left TEA was performed in October 2024. The post-operative course was uneventful, with progressive functional recovery. At the most recent follow-up, the patient reported no elbow pain, good bilateral upper-limb function, and high satisfaction with the staged treatment.

CONCLUSION

Staged bilateral TEA can provide clinically meaningful pain relief and restoration of autonomy in selected patients with advanced rheumatoid elbow destruction. This case highlights the importance of assessing the global upper-limb functional burden and planning treatment according to patient frailty, comorbidities, expectations, and bilateral disease progression.