Total Elbow Replacement

What is Total Elbow Replacement?

Elbow Joint Replacement, also referred to as Total Elbow Arthroplasty, is an operative procedure to treat the symptoms of arthritis that have not responded to non-surgical treatments.

Elbow Anatomy

The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow forming the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

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. Often the definite cause is unknown.

When the articular cartilage wears out, the bone ends rub on one another causing pain. In general, but not always, arthritis affects people as they get older.

Indications for 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 such as medications or steroid injections.

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
• Tumour or growth in the elbow joint
• History of previous elbow surgery

Diagnosis of Arthritis

Elbow conditions should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment. Your surgeon will study your medical history and perform a physical examination

Tests will also be ordered and may include X-rays and MRI scans.

Total Elbow Replacement Procedure

Elbow joint replacement surgery is an option that your surgeon may recommend if your overall health is good and you have not had success with conservative treatment options.

The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint. The surgery is performed under sterile conditions in an operating room under general or regional anaesthesia 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 cut off with a surgical saw to create a smooth surface to attach the implants.
• A special instrument is used to hollow out the inside of the humerus bone to insert the humeral component of the prosthesis.
• Once a proper fit is established, the 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 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.
• The surgeon then irrigates the new joint with sterile saline.
• The surgeon then sutures the joint capsule together, repairs the muscles and tendons and sutures the skin closed usually with a drain in place to help any blood drain 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 and the surgeon’s preference.

Common post-operative guidelines include:

• 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 the patient to push a button to deliver a dose of pain medicine through the 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 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 otherwise 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 include:

• Infection
• Fractures of the humerus or ulna bone
• Dislocation of the elbow
• Damage to nerves of blood vessels
• Blood clots (Deep Venous Thrombosis)
• Loosening of artificial components
• Wound irritation
• Failure to relieve pain