If you've damaged your elbow whilst playing sports or developed rheumatoid arthritis in your elbow joint, it might be necessary to arrange an elbow replacement operation (or elbow arthroplasty). Elbow replacements ease the pain caused by degraded cartilage and bone-on-bone contact, providing a wider range of movement and a higher quality of life.
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Elbow Replacement Quick Details
WHO IS THIS FOR
Patients with rheumatoid or osteoarthritis in their elbow joint and significant degrees of pain resulting from their condition.
Elderly patients who have sustained distal humeral fractures.
Younger patients with arthritic elbow conditions who have considered other treatment options without positive results.
People suffering from post-traumatic arthritic conditions which may result from sporting injuries or road accidents.
The elbow replacement operation lasts between two to three hours. A hospital stay of two to three days will also be required.
It generally takes between four to six weeks before patients can place weight on their affected elbow.
Full recovery can take longer, although patients can return to light work after six weeks.
The success rate for patients suffering from rheumatoid arthritis is high, with 97% reporting no or mild pain in follow up studies.
In 92.4% of these cases, no revision was required after ten years.
POTENTIAL RISKS & SIDE EFFECTS
Infection (seen in 2-4% of cases)
Ulnar neuropathy (around 5%)
Mechanical failure (possibly a factor in 5-10% of cases)
Periprosthetic fractures resulting from the presence of implants
What Is an Elbow Replacement?
In elbow replacement procedures (also known as elbow arthroplasty), surgeons replace damaged and painful elbow joints with artificial joints. The implants mimic the hinged mechanism of the human elbow and attaches to the three major bones in the lower arm (the humerus, radius and ulna). This restores mobility and eases the pain associated with conditions like rheumatoid or osteoarthritis.
How Do Elbow Replacements Work?
Elbow replacements are very simple but need to be carried out by skilled surgeons to ensure proper implementation. Basically, they are a simple exchange of the original muscle and bone for prosthetic alternatives. The elbow replacement process may vary slightly from case to case, but a standard schedule would be as follows.
1. You will meet with a physician to discuss health issues relating to your elbow joint. This is a chance to discuss whether a replacement is required, the type of implant and to arrange a date for the operation.
2. Your physician will also make recommendations about preparing for the operation. Typically, this will require the cessation of NSAID painkillers and other anti-arthritis medication two weeks before your hospital admission.
3. On the day of the operation, you will be administered a general anaesthetic. The surgeon will then make an incision behind the elbow providing access to the joint.
4. Any damaged muscle tissue or bone spurs on the joint will be removed, and your surgeon will prepare the ulna and humerus bones to receive the hinged implant.
5. The implant is attached to both bones via elongated stems which sit inside the bone canal and are fixed in place with cement.
6. When the hinge is in place the incision wound will be closed, stitched and dressed. A stent will also be inserted into the joint to drain any excess fluid.
7. After the operation is concluded, you should be able to return home within two to three days.
8. Following the operation, you will need to wear a sling for around three weeks. It will also be necessary to carry out specific exercises over a period of two to three months to re-establish normal joint mobility.
Are There Different Types of Elbow Replacement?
There are two major types of elbow replacement operation - linked and unlinked.
Linked elbow replacements are more common. In these procedures, the implant is as described above - two sections are attached to the ulna and humerus, with a hinge pin connecting them together. This form of elbow replacement generally provides an excellent range of movement but complications can sometimes arise if either part becomes dislocated from the bone it is attached to.
Unlinked elbow replacements are not connected in the same way. In these procedures, the surfaces of the ulna and humerus are replaced by prosthetic implants, but there is no connecting hinge pin. Instead, a connection is provided by ligaments in the patient's arm. These implants are often favoured when operating on younger, fitter individuals due to their relatively lower rates of wear and tear.
In some cases, doctors may recommend partial elbow replacements as well. This applies in cases where a total elbow replacement is deemed unnecessary, and a prosthetic implant will be applied to the ulna or humerus alone.
What Should I Expect?
When you undergo an elbow replacement, you can expect a hassle-free hospital stay and operation. Success rates for the operation itself are extremely high, and the vast majority of people return home a couple of days after their procedure. However, it's important to realise that the recovery process takes time and focus. At first, it is essential to follow antibiotic doses carefully to prevent infection. A sling must be worn as directed to ensure the implants "bed in" properly, and prescribed exercises involving the hand, wrist and elbow joint will help to make rehabilitation faster and more effective.
There may also be some pain along the way. Elbow replacements are invasive procedures and can result in swelling. This is very normal and, in most cases, easily manageable - your doctor can prescribe painkillers to help manage any pain that arises. If you follow recommendations from specialists and the procedure went well, you can return to driving, comfortable typing and light work duties within six weeks. However, sports, heavy lifting and many other demanding tasks may not be possible. To minimise the risk of damage, always consult your doctor to establish the limits of your capabilities.