What is Total Elbow Replacement?
Elbow joint replacement, also called total elbow arthroplasty, is an operative procedure to treat the symptoms of arthritis that have not responded to non-surgical treatments. The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint.
Indications for Total Elbow Replacement
Your surgeon may recommend elbow joint replacement surgery to treat severe arthritis that has not responded to conservative treatment options.
Other indications for elbow joint replacement surgery may include:
- Severe elbow fracture in older patients with osteoporosis; a disease that causes bone loss and raises the risk of fractures
- Tumor or growth in the elbow joint
- History of previous elbow surgery
- Your overall health is good
Total Elbow Replacement Procedure
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 with a surgical saw to create a smooth surface for the attachment of the implants.
- A special instrument is used to hollow out the humerus bone’s inside to insert the prosthesis’s humeral component.
- 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 prepared with or without cement, depending on your surgeon’s preference.
- The components are then inserted and put together, 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, usually with a drain, to help drain blood from the area.
- The elbow is then dressed and bandaged.
Postoperative Care for Total Elbow Replacement
After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed. The standard postoperative procedures include the following:
- You will probably stay in the hospital 4-5 days after the surgery.
- Your pain will be managed with a PCA machine (patient-controlled analgesia), injections, or pain pills. A PCA machine enables you to push a button to deliver a dose of pain medicine through IV.
- Your arm will be in a sling or splint with a bulky dressing.
- You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 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 the full range of motion of the elbow joint.
- Sutures will usually be removed after 10-14 days.
- Keep the incision clean and dry. You may shower once the dressings are removed unless directed by your surgeon.
- You will be given specific instructions regarding activity and rehabilitation.
- Eating a healthy diet and not smoking will promote healing.
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:
- 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
- Wound irritation
- Failure to relieve pain