Elbow replacement surgery

Overview

Elbow replacement surgery removes damaged areas of the elbow joint and replaces them with parts made of metal and plastic. These are known as implants. This surgery also is called elbow arthroplasty.

Three bones meet in the elbow. The upper arm bone, called the humerus, connects like a loose hinge to the larger of the two forearm bones, called the ulna. The two forearm bones, the radius and the ulna, work together to allow the forearm to rotate.

Traditionally, elbow replacement surgery has had a higher rate of complications than surgeries to replace hip or knee joints. But recent advances in surgical technique and implant design have improved the success rate of elbow replacements.

Why it's done

Your elbow can be damaged by conditions ranging from arthritis to fractures and other injuries. In many cases, the damage from arthritis and fractures can be surgically repaired. However, if the damage is too serious, replacement is usually better.

Pain and loss of motion are the most common reasons people choose to have elbow replacement surgery.

Conditions that can damage the joint include:

• Many types of arthritis.
• Bone fractures.
• Bone tumors.

Elbow replacement procedures

In some cases, you may need a replacement of just one portion of the joint. For example, if only the head of one of your forearm bones, the radius, is damaged, it can be replaced with an artificial radial head.

If the entire joint needs to be replaced, the ends of the bones that come together in the elbow are reshaped. Bones are hard tubes that contain a soft center. The long, slender ends of the artificial parts are inserted into the softer central part of the bones. The parts are usually attached with bone cement.

If the surrounding ligaments aren't strong enough to hold the joint together by themselves, the surgeon may use a linking cap. This connects the artificial implants so they can't come apart.

Risks

Although rare, it's possible that elbow replacement surgery won't lessen the pain or make it go away completely. The surgery may not fully restore the movement or strength of the joint. Some people may need another surgery.

Potential complications of elbow replacement surgery include:

• Implant loosening. Elbow replacement components are durable, but they may loosen or become worn over time. If this happens, another surgery may be needed to replace the loose components.
• Fracture. The bones in the elbow joint can break during or after surgery.
• Nerve damage. Nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.
• Infection. Infection can happen at the incision site or in the deeper tissue. Surgery is sometimes needed to treat an infection.

How you prepare

Before surgery is scheduled, you meet with your surgeon. This visit most often includes:

• A review of your symptoms.
• A physical exam.
• X-rays and sometimes computerized tomography (CT) of your elbow.

Some questions you may want to ask include:

• What type of implants do you recommend?
• How will I manage my pain after surgery?
• What kind of physical therapy will I need?
• How will my activities be restricted after surgery?
• Will I need to have someone help me at home for a while?

Other members of the healthcare team check your readiness for surgery. They also ask about your medical history and medicines you take.

What you can expect

Before the procedure

Follow your surgeon's directions about bathing, eating and taking medicines the day before and the day of surgery.

During the procedure

A care team member talks with you about how you'll be sedated for surgery. Most people get medicine that puts them into a deep sleep, called general anesthesia, and a nerve block. The nerve block numbs your arm so that pain control can continue after you wake up from general anesthesia. The surgery usually takes 1 to 2 hours.

After the procedure

After surgery, you rest in a recovery area for a short time. How long you stay in the hospital after surgery depends on your individual needs. Many people can go home the same day.

You may need to wear a splint or a sling for a few days or weeks after surgery. You may also need a temporary device called a drain to avoid pooling of fluids at the elbow. Your healthcare team explains how to do exercises to help your recovery.

Results

After elbow replacement, most people have less pain than they did before surgery. Many people have no pain. Most people also have improved range of motion and strength.