Elbow replacement

• Alternative Names

  Total elbow arthroplasty; Endoprosthetic elbow replacement

• Description

  The elbow joint is made up of 2 bones: 1 from the upper arm (the humerus) and 1 from the lower arm (the ulna). The artificial elbow joint has 2 stems made of high-quality metal. A metal and plastic hinge joins the stems together and allows the artificial joint to bend. Artificial joints come in different sizes to fit different-size people.

  You may receive general anesthesia before surgery. This means you will be unconscious and unable to feel pain. You may receive regional anesthesia instead. You will be awake, but your arm will be numb so that you will not feel pain. If you receive regional anesthesia, you will also be given medicine to help you relax during the operation.

  Your surgeon will make an incision (cut) to expose your elbow joint. Usually this incision is made in the back of the upper and lower arm.

  • Your surgeon will remove the sections of the humerus and the ulna that make up your elbow joint. Any damaged tissue will also be removed.
  • Then your surgeon will drill out part of the center of the humerus and ulna. An end of the artificial joint stems will be inserted into each bone.
  • Usually, bone cement is used to hold the stems in place.
  • Next, your surgeon will attach the 2 stems together with the hinge.
  • Your incision will be closed with sutures (stitches). It will be bandaged, and your arm may be placed in a splint to keep it stable.
• Why the Procedure Is Performed

  Elbow replacement surgery is usually done if the elbow joint is badly damaged and you have pain or cannot use your arm. Some causes of damage are:

  • Osteoarthritis
  • Poor outcome from previous elbow surgery
  • Rheumatoid arthritis
  • Badly broken bone in the upper or lower arm near the elbow
  • Badly damaged or torn tissues in the elbow
  • Tumor in or around the elbow
• Risks

  The risks for any anesthesia are:

  • Allergic reactions to medicines
  • Breathing problems

  The risks for any surgery are:

  • Bleeding
  • Blood clot
  • Infection

  Additional risks of elbow replacement surgery are:

  • Allergic reaction to the artificial joint
  • Blood vessel damage during surgery
  • Bone break during surgery
  • Dislocation of the artificial joint
  • Loosening of the artificial joint over time
  • Nerve damage during surgery
• Before the Procedure

  Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

  During the 2 weeks before your surgery:

  • You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
  • Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
  • If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing.
  • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

  On the day of your surgery:

  • You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take your drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.
• After the Procedure

  You may stay in the hospital for up to 3 or 4 days.

  You may have a splint on your arm to help stabilize your elbow. Your doctor will prescribe physical therapy to help you gain strength and use of your arm. Physical therapy will start with gentle flexing exercises. People who have a splint usually start therapy a few weeks later than those who do not have a splint.

  Some people may start to have use of their new elbow as soon as 12 weeks after surgery. But complete recovery can take up to a year.

• Outlook (Prognosis)

  Elbow replacement surgery eases pain for most people. A second elbow replacement surgery is usually not as successful as the first one.

• References

  Gallo RA, Payatakes A, Sotereanos DG. Surgical options for the arthritic elbow. J Hand Surg. 2008 May-Jun;33(5):746-59. PMID: 18590859.

  Azar FM, Calandruccio JH. Arthroplasty of the shoulder and elbow. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 8.

Review Date: 2/3/2009

Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.