Elbow Replacement
By Roger C. Sohn, MD
Elbow Anatomy
The elbow joint is made up of 3 bones which come together to form a hinge joint. The upper arm bone or humerus forms the top of the hinge joint. The forearm consists of two bones, the radius, and the ulna. These bones form the lower portion of the hinge joint. Many muscles cross this joint allowing the elbow and wrist to perform moving and grasping motions. We use the elbow continuously for so many activities that people often refer to needing “elbow grease” to keep things done.
What is Arthritis?
Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain-free movement in the joint. This surface can wear out for several reasons. When the articular cartilage wears out, the bone ends rub on one another, causing pain, swelling, stiffness, and interference with the use of the arm. This process tends to affect people in their 50’s or older. In the case of injury, the problem can arise earlier in life.
Treatment Options for Elbow Arthritis
Treatment can include conservative options such as medications and steroid injections to relieve pain, activity modification and use of splints, or surgery.
What is Total Elbow Replacement?
Elbow joint replacement, also referred to as total elbow arthroplasty, is an operative procedure used to treat arthritis related pain and stiffness. The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint. The surgery involves placing an artificial joint made of metal into the humerus and ulna. There is a bearing made of high density polyethylene which cushions the new hinge joint.
Who Should Get a Total Elbow Replacement?
Elbow joint replacement surgery may be recommended by your surgeon for the treatment of severe arthritis that has not responded to conservative treatment options.
Other indications for elbow joint replacement surgery may include:
- Severe elbow fractures in older patients with osteoporosis
- A tumor in the elbow joint
- Previous elbow injuries or surgeries which result in late arthritis
How is a Total Elbow Replacement Done?
The surgery is performed under sterile conditions in an operating room under general or regional anesthesia and involves the following steps:
- An incision is made over the back of the elbow.
- The muscles are retracted, and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.
- The damaged joint surfaces of the humerus, radius, and ulna are trimmed to create a smooth surface for the attachment of the implants.
- Once a proper fit is established, your surgeon repeats this procedure on the ulna bone to prepare it for the ulnar component of the prosthesis.
- The humerus and ulna bones are then prepared with or without cement, depending on the strength of the bone.
- The components are then inserted and linked, ensuring proper movement of the hinge portion of the prosthesis.
- With all the new components in place, the joint is tested through its range of motion.
- Your surgeon then irrigates the new joint with sterile saline.
- The joint capsule is then sutured back together, the muscles and tendons are repaired and the skin sutures.
- The elbow is then dressed and bandaged.
What is the Postoperative Care for Total Elbow Replacement?
After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed. The common postoperative guidelines include the following:
- You will probably go home on the same day of the surgery.
- Your arm will be in a sling with a bulky dressing.
- In rare cases, you may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 days.
- Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.
- Occupational therapy (OT) will begin soon after surgery and continue for about 3 months to regain full range of motion of the elbow joint.
- Sutures will usually be removed after 1 week.
- Keep the incision clean and dry. You may shower once the dressings are removed at your first postop check.
- You will be given specific instructions regarding activity and rehabilitation.
- Eating a healthy diet and not smoking will promote healing.
What are the Risks and Complications of Total Elbow Replacement?
Most patients suffer no complications following elbow joint replacement. However, complications can occur following elbow surgery and may include:
- Infection
- Fractures of the humerus or ulna bone
- Dislocation of the elbow
- Damage to the nerves or blood vessels
- Blood clots (deep venous thrombosis)
- Loosening of artificial components
- Failure to fully relieve pain