From the Guidelines
The next step in management for an 86-year-old male with osteoarthritis and a large intraarticular loose body in the elbow should be to consider referral for surgical consultation, as the presence of a loose body can cause mechanical symptoms. Given the patient's age and the presence of a large intraarticular loose body, it is essential to weigh the potential benefits of surgical intervention against the risks. According to the study by 1, referral for surgical interventions such as arthroscopic lavage and debridement should not be routinely offered unless there is a clear history of mechanical locking. However, in this case, the presence of a large loose body may be causing mechanical symptoms, and thus, surgical consultation for loose body removal should be considered. Before referring the patient for surgery, it is crucial to ensure that he has been offered core treatment options, including pain management and physical therapy. The study by 1 suggests that patient-specific factors, such as age, should not be barriers to referral for joint replacement surgery or other surgical interventions. The decision for surgery should be based on discussions between the patient, referring clinicians, and surgeons, taking into account the patient's overall health status, functional limitations, and goals. Key considerations in the management of this patient include:
- Pain control with medications such as acetaminophen or NSAIDs, with careful monitoring of side effects
- Physical therapy to maintain range of motion and strength
- Potential intra-articular corticosteroid injection for additional pain relief
- Surgical consultation for loose body removal if conservative measures fail to provide adequate relief.