- Procedure Details
- Risks / Benefits
- Recovery & Outlook
The elbow is one of many joints in the human body that serve as connection points for bones and contribute to our range of movement. Elbow replacement is less common than similar procedures for the knee or hip. However, the total elbow replacement process can be successful in relieving pain and other problems.
Anatomy of the Elbow
At the elbow joint, the upper arm bone (humerus) and forearm bones (ulna and radius) come together and are connected by a series of muscles, ligaments, and tendons. The ends of these bones have surfaces covered in articular cartilage, which eases movement, while the synovial membrane covers other surfaces and lubricates the cartilage by producing fluid. This fluid counteracts the friction that bending and rotating your arm can create.
There are two joints in the elbow. The humerus and ulna form the ulnohumeral joint, a hinge enabling flexion, or the ability to straighten and bend your arm. At the junction of the radius and ulna, the radioulnar joint lets you pivot and rotate your forearm. Together, these joints allow for the full range of motion in our forearms.
Why Have a Total Elbow Replacement?
Severe pain, problems with movement, instability, deformity, or deterioration of the joint are some reasons to seek a total or partial elbow replacement. There are several reasons a doctor can recommend arthroscopic elbow joint replacement for. Some of these are:
Severe bone fractures in the elbow often don’t heal properly, especially if multiple bones are broken and in pieces. A shattered elbow is hard to put back together, so replacing the hinge joints is often recommended. Severe breaks can cut off the blood supply, further affecting bone health and the ability to recover without surgery.
After a fracture or broken bone, the cartilage at the ends of bones may gradually wear away. Damage to cartilage is even more likely if any tendons or ligaments are torn. Pain, swelling, and stiffness progressively get worse.
Generally age-related, osteoarthritis is typically caused by wear and tear. The worn cartilage causes bones to rub together. Moving your elbow will become difficult and painful over time.
Affecting the connective tissues, this condition leads to irritated and overgrown joint linings, destroying cartilage and other parts of the joint. The disorder leads to pain, deformity, and involvement of the hands, shoulders, and other joints where it takes hold.
Damaged ligaments make for an unstable elbow because these tissues hold the joint together. If ligaments aren’t working well, which can be caused by injury or disease, your elbow will be prone to dislocation. Sudden issues can occur with normal activities and movements.
A physical examination usually takes place in the weeks leading up to total elbow replacement. This makes sure no underlying health issues can impact the surgery and recovery, and that chronic conditions are well-managed. You’ll meet with your orthopedic surgeon to discuss the procedure and whether to stop taking any medications that can cause bleeding. These include arthritis and non-steroidal anti-inflammatory medications, as well as blood thinners. Your doctor will also instruct you on when to stop eating and drinking prior to the surgery.
At home, move hard-to-reach items to lower shelves, and arrange for any help post-surgery for dressing or bathing, or doing laundry or cooking. The day of the surgery, you will probably be admitted to the hospital. A general anesthetic is often used, so you’re asleep during the procedure.
Total Elbow Replacement Process
The surgery typically begins with an incision made at the back of the elbow. Muscles are moved so the surgeon can access the bone, and spurs and scar tissue are removed as needed. Special instruments are used to drill into the humerus and ulna, so metallic components, made of titanium or a chrome-cobalt alloy, can be placed; a polyethylene liner covers the ends. Bone cement secures these metal stems, and a hinge pin then connects the two.
The surgeon then closes the wound and wraps it in a padded dressing. In some cases, a tube is left in the joint to drain fluid. It is usually removed after the first few days, which is done in the hospital room.
How Long Does Elbow Replacement Surgery Last?
Surgery generally takes about two hours, but operating time can vary from one patient to another, depending on the problem and its extent. The joint replacement can last for 10 years. Revision surgery, or a second joint replacement, is possible if the implant has loosened or worn out.
Elbow Replacement Complications and Outcomes
Complications can include infection, nerve injury, and wound healing problems. Problems with the implant can arise as well. Parts may loosen, or the plastic liner can wear out; such issues and a broken implant requires additional surgery to correct. Loosening, fracture, instability, and infection are more common than with other joint arthroplasties. However, most patients benefit from total elbow replacement surgery and see an improved quality of life overall.
Recovery & Outlook
After surgery, you will be in the hospital for two to four days. Antibiotics will be administered to prevent infection, but you will most likely eat solid food and be allowed to get out of bed the next day. You’ll need to constantly keep your arm elevated.
Total elbow replacement is associated with some pain, so pain management will be a part of your recovery. Pain is part of the healing process, but your medical team will work to help ease the discomfort with local anesthetics, non-steroidal anti-inflammatory drugs, and opioids.
Once a lighter dressing is applied, you’ll be able to move the arm operated on with your other arm. A physiotherapist will help in the beginning, as part of your total elbow replacement rehab. As you use the other arm to move the recovering one (during eating and other activities), you’ll gradually gain strength and mobility. You should gradually need less help from the other arm.
Range-of-motion exercises and physical therapy will help increase your independence. For six weeks, don’t put any weight on your arm or push on anything with your hand.