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Elbow Joint Replacement

Elbow joint replacement, also referred to as total elbow arthroplasty, is an operative procedure to relieve symptoms of arthritis that have not responded to non-surgical treatments.

The arm in the human body is made up of three bones that join together 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 ulna. These bones connect the wrist to the elbow, forming the bottom portion of the hinge joint.

The joint surface is covered by a smooth articular surface made of cartilage that allows pain-free movement. Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. When the articular cartilage wears out, the bone ends rub against each other, causing pain. The surface can wear out for a number of reasons. Often, the definite cause is unknown. In general, but not always, arthritis affects people as they get older.

Indications

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)
Tumor or growth in the elbow joint
History of previous elbow surgery

Diagnosis

Elbow conditions should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment. Your surgeon will review your medical history and perform a thorough physical examination. Tests will also be ordered and may include X-rays and MRI scan.

Surgical 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 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 the side 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 for the attachment of the implants.
A special instrument is used to hollow out the inside of the humerus bone in order 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 blood drain from the area.
The elbow is then dressed and bandaged.

Postoperative care

After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed.

You will probably stay in the hospital for 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 deliver a dose of pain medicine yourself through IV, by pushing a button.
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 your 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.