Elbow Replacement

What is Elbow Replacement?

The elbow has several moving parts, which help to balance each other and control the movements of your forearm. Your elbow can be damaged by rheumatoid arthritis and traumatic fractures. In such cases, the damage can be surgically repaired but if the damage is extensive, your physician might recommend elbow replacement surgery. Pain is a common reason why most people choose to have elbow replacement surgery.

An elbow replacement surgery is a surgical procedure used to replace your elbow with an artificial joint, made from two implants which are attached to the bones in your arm, and the metal and plastic hinge joins the implants together.

What is the Anatomy of an Elbow?

The elbow is a hinge joint which consists of three bones:

• The humerus (upper arm bone)
• The ulna (lower forearm bone)
• The radius (lower forearm bone on the thumb side)

In a healthy elbow, synovial membrane produces a small amount of fluid, to lubricate the cartilage and eliminate any friction as you bend and rotate your arm. Muscles, ligaments, and tendons help to hold the elbow joint together. 

What are the Types of Elbow Replacement?

You may need a replacement of just one portion of the joint or a whole portion of the joint. In case the head of one of your forearm bones (radius) is damaged, it can be replaced with an artificial head i.e. partial elbow replacement surgery. If you require total elbow replacement surgery (whole joint needs to be replaced), then the ends of the bones which come together in the elbow should be removed. Bones are hard tubes containing a soft center, and the long and slim ends of the artificial joint, are inserted into the softer central part of the bones.

The two types of prosthetic devices that are used in the surgery are:

• Linked – This type of prosthesis will act as a loose hinge because all the parts of the replacement joints are connected. This provides good joint stability, but the movement can sometimes result in the prosthesis becomes loose in the arm bones.

• Unlinked – This type of device comes in two separate pieces that are not connected. This design will depend on the surrounding ligaments, to help in holding the joint together which makes it more prone to dislocation.

Who Requires an Elbow Replacement?

Elbow replacement surgery is required if the elbow joint is badly damaged or you cannot use your arm because of severe pain. Some causes of damage are:

• Osteoarthritis
• The poor outcome from past elbow surgery
• Rheumatoid arthritis
• Severe Fractures
• Damaged or torn tissues in the elbow
• Tumor in or around the elbow
• Stiff elbow

How is the Elbow Replacement Performed?

Elbow replacement surgery is performed with general anesthesia or you will receive regional anesthesia (spinal and epidural) to numb your arm. Elbow replacement surgery takes about 2 hours and the hospital stay will last for 2 or 3 days.

Step 1 – To reach the elbow joint, your surgeon will make an incision (cut), usually at the back of the elbow. 

Step 2 – After making the incision, your surgeon will gently move muscles aside to get access to the bone. 

Step 3 – The damaged tissue and parts of the arm bones that make up the elbow joint are removed.

Step 4 – your surgeon will prepare the humerus to fit the metallic piece that will replace that side of the joint. The same preparation is done for the ulna. The replacement stems will be placed into the humerus and ulna bones and fixed with bone cement. The two stems will be connected by a hinge pin. 

Step 5 – After the wound is closed, a padded dressing is then placed to protect the incision while it heals. Some surgeons will place a temporary tube in the joint to drain surgical fluid. This tube can be easily removed in your hospital room within a few days after the surgery.