What is an Elbow Replacement?
Elbow replacement involves replacement of the elbow joint with an artificial joint, typically made of metal and high grade plastic. The primary goal of surgery is to improve pain. By treating elbow pain most patients also achieve an improved range of motion and functional level. You may benefit from an elbow replacement if you have painful arthritis of the elbow that has not responded to other treatment modalities or if you have had a severe trauma to the elbow that is not possible to be treated by ‘fixation’.
What types of elbow replacement are there?
Broadly speaking an elbow replacement may be a total replacement or a partial replacement. Total elbow replacement involves replacement of all the bony surfaces that make up the normal joint so that the articulation between the components is completely artificial. A partial elbow replacement or hemiarthroplasty is when only one surface of the joint is replaced, such that the articulation is between an artificial implant and the opposing native bone of the patient. A hemiarthroplasty is most often performed in trauma where only part of the joint is fractured rather than in arthritis where the whole joint is affected. Some total elbow replacements are linked, like a hinge and others are unlinked with no connection between the components. Your surgeon will recommend you the type of elbow replacement on an individualized basis.
What happens on the day of surgery?
You will be admitted on the morning of the surgery and will be seen by your surgeon and the anaesthetist. You will be asked to sign a consent form for surgery and the details of the anaesthetic will be explained to you. We recommend a block of the nerves in the arm which means you will wake up from the anaesthetic with minimal discomfort. The surgery itself takes 1-2 hours and you are likely to be in hospital for 1-2 nights. You will wake up with a bulky bandage on the arm and a sling for comfort. The day after surgery we will arrange for an x ray to check the position of the implants and you will see a physiotherapist to plan your rehab.
What does rehabilitation involve following surgery?
Following elbow surgery we are usually keen to get the joint moving to minimize stiffness. Sometimes after an elbow replacement we may rest the elbow in a splint for a week or two to allow the wounds to heal before commencing motion. You may be provided with a night splint to maintain your range of motion if your elbow is very stiff. Because elbow replacements are generally not as durable s hip or knee replacements we tend to recommend that you do not perform heavy lifting, sports that involve your arm or repetitive lifting with that arm in the long term. This is to minimize the chance of early loosening and the need for revision surgery. You will have an individualized rehabilitation plan to guide you through the recovery process.
What are the main complications of elbow replacement?
The infection risk is between 2-5%. If you develop an infection, it is likely that your surgeon will recommend further surgery to eradicate the infection. In severe cases this might mean removing the implants.
Several nerves are at risk during elbow surgery, however the ulna nerve is the most vulnerable. If this nerve is stretched or injured, it may result in numbness or tingling in the little and ring finger. In severe cases there may be weakness in the hand.
This is where the components separate from each other. If this happens you are likely to require further surgery to correct the problem.
A fracture of the bones can occur during placement of the implants or following surgery if you have a fall or injury to the arm. This may or may not require further surgery depending upon the problem.
The components of an elbow replacement are fixed into the bone using bone cement, however with cyclic use over time these components may loosen. If this is causing symptoms you may require revision surgery to exchange the implants.
Elbow replacement will usually result in an improvement in your range of motion, however patients who have very stiff elbows before surgery will regain less motion after surgery than those who have a good pre-operative range of motion.