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Total Elbow Replacement

Other popular names

Who does it affect?

People suffering from arthritis.  In elderly patients, may be required due to injury (Trauma).

What is it?

Total elbow arthroplasty is the replacement of a native elbow joint with a synthetic elbow joint (usually made of metal and plastic). 

When is elbow arthroplasty surgery recommended?

There are two major reasons for elbow replacement surgery, arthritis and trauma / injury.

a. Elbow arthritis

Rheumatoid arthritis is a condition that affects a number of joints in the body with pain and inflammation as the key indicators.  People of all ages may be affected.  Patients with rheumatoid arthritis make up the largest group that undergo total elbow replacement but the numbers needing this surgery are declining with improvements in the medical care of rheumatoid arthritis.

Osteoarthritis is another type of arthritis, often described as wear and tear of the joint.  It is characterised by involvement of only one or a few joints of the body.  Pain, stiffness and swelling are the key features.  It generally affects people later in life.  Elbow arthroplasty is only occasionally used in people with this type of arthritis as a method of relieving pain when pain-killing medication does not work.

b. Elbow trauma

Very occasionally elbow arthroplasty may be recommended when an individual has an injury to the elbow that cannot be fixed either because the bone is broken into too many pieces or because the quality of the bone is not suitable for fixation.  This is more commonly the case in the elderly.
Hemiarthroplasty of the elbow is the replacement of one part of the elbow joint with a synthetic elbow joint (usually made of metal).  Usually the surgery involves replacement of the end of the humerus (upper arm) bone at the elbow joint.

Diagnosis

Bone damage is examined by x-ray.

Non-surgical treatment

Due to chronic damage, the use of plaster casts or other means will not help and surgery is the only available option.

Surgical treatment

Surgery is carried out under general anaesthetic and takes about 20-50 minutes. In many cases we also apply an arm block, which is an injection around the shoulder to temporarily prevent the nerves in the arm from carrying pain signals to the brain.  The aim of this bock is to lessen the post-operative pain in the elbow.  It will also have the effect of temporarily paralysing the arm on the day of the surgery.
An incision is made on the back of the elbow to remove the damaged elbow and implant an elbow hemiarthroplasty.   After the surgery you will have a bandage on the elbow and you may also have a splint to rest the elbow. 

Post-surgery rehabilitation

You can expect to stay in hospital for between two and three days.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed after 2 days.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks.  The sutures are removed at about 12 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.

Return to normal routine

Keep the wound dry until the stitches are out at 12days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).

Specific risks:

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