Painful and unstable elbow joints frequently limit or prohibit successful use of a normal hand in activities of daily living. Semi-constrained elbow replacement is an alternative to elbow fusion.

This surgical procedure is suited for active people who agree not to hammer, use pneumatic tools and try to avoid any activity that might cause a fracture in a normal elbow due to a fall, such as unprotected roller blading or skate boarding.

Elbow Replacement Candidates

Candidates are people with severe deterioration due to osteoarthritis, rheumatoid arthritis or the metabolic arthritides in one or both elbows, or in the non-dominant elbows of someone who must perform extreme activities in his or her profession. In the case where one of the arthritic elbows has been previously infected and is not a candidate for joint replacement, the uninfected elbow may be replaced while the only option for the infected elbow is fusion.

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

Elbow Replacement Outcome & Benifits

The most common reason for an artificial elbow replacement is arthritis. There are two main types of arthritis, degenerative and systemic. Degenerative arthritis is also called wear-and-tear arthritis, or osteoarthritis. Any injury to the elbow can damage the joint and lead to degenerative arthritis. Arthritis may not show up for many years after the injury.

Prepare for Elbow Replacement

You and your surgeon should make the decision to proceed with surgery together. You need to understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.

Once you decide on surgery, you need to take several steps. Your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.

You may also need to spend time with the physical or occupational therapist who will be managing your rehabilitation after surgery. This allows you to get a head start on your recovery. One purpose of this pre-operative visit is to record a baseline of information. Your therapist will check your current pain levels, ability to do your activities, and the movement and strength of each elbow.

A second purpose of the pre-operative therapy visit is to prepare you for surgery. You'll begin learning some of the exercises you'll use during your recovery. And your therapist can help you anticipate any special needs or problems you might have at home, once you're released from the hospital.

On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before. Come prepared to stay in the hospital for at least one night.

Elbow Replacement Surgery Overview

Elbow replacement surgery involves replacing an elbow joint with an artificial (prosthetic) joint to relieve pain and improve elbow motion. Elbow replacement surgery is a treatment option for people with severe arthritis, difficult-to-treat fractures, significant tissue damage and tumors in the elbow region.

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.

Getting to the Joint

The patient is first taken into the operating room and given anesthesia. After the anesthesia has taken effect, the skin around the elbow is thoroughly scrubbed and sterilized with an antiseptic liquid. A tourniquet is then applied to the upper portion of the arm to help slow the flow of blood.

An incision about six inches long is then made over the elbow joint. The incision is gradually made deeper through muscle and other tissue until the bones of the elbow joint are exposed.

Preparing the Bones

One of the forearm bones, the ulna, has a projection at the end, which extends up and behind the end of the humerus. A special power saw is used to remove part of this projection.

This allows the two forearm bones to be rotated out of the way so parts of the humerus can be removed with the saw. Precision guides are used to help make sure that the cuts are made so the bones will align properly after the implant is inserted.

The middle portion at the end of the humerus is removed first.

The arm bones have relatively soft, porous bone tissue in the center. This part of the bone is called the "canal." Special instruments are used to clear some of this soft bone from the canal of the humerus. These instruments also help shape the canal to fit the shape of the implant.

Then, similar instruments are used to clear some of the soft bone and shape the canal of the ulna.

Attaching the Implants

The elbow implant consists of two metal stems that are connected by a metal locking pin. This pin passes through the ends of both stems, which are lined with a strong plastic material, serving as a bearing that allows the elbow to bend. The stems are inserted into each of the two prepared canals. A special kind of cement for bones is first injected into the canals to help hold the stems in place.

When the cement is hard, the two implant parts are brought together and the pin is inserted to connect them.

Stems Locked Together to Create Hinge

Closing the Wound

If necessary, the surgeon may adjust the ligaments that surround the elbow to achieve the best possible elbow function.

When all of the implants are in place and the ligaments are properly adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. The edges of the skin are then sewn together, and the elbow is wrapped in a sterile bandage. Finally, the patient is taken to the recovery room.

Elbow Replacement Recovery

After surgery, your elbow will probably be covered by a bulky bandage and a splint. Depending on the type of implant used, your elbow will either be positioned straight or slightly bent. You may also have a small plastic tube that drains blood from the joint. Draining prevents excessive swelling from the blood. (This swelling is sometimes called a hematoma.) The draining tube will probably be removed within the first day. Assisted elbow movements are started by an occupational or physical therapist the day after surgery.

Your surgeon will want to check your elbow within five to seven days. Stitches will be removed after 10 to 14 days, though most of your stitches will be absorbed into your body. You may have some discomfort after surgery. You will be given pain medicine to control the discomfort you have.

You should keep your elbow elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting.

Elbow Replacement After Care

A physical or occupational therapist will direct your rehabilitation program. Recovery takes up to three months after elbow replacement surgery. The first few therapy treatments will focus on controlling the pain and swelling from surgery. Heat treatments may be used. Your therapist may also use gentle massage and other types of hands-on treatments to ease muscle spasm and pain.

Then you'll begin gentle range-of-motion exercises. Strengthening exercises are used to give added stability around the elbow joint. You'll learn ways to lift and carry items in order to do your tasks safely and with the least amount of stress on your elbow joint. As with any surgery, you need to avoid doing too much, too quickly.

Some of the exercises you'll do are designed get your elbow working in ways that are similar to your work tasks and daily activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your new elbow joint. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.

Your therapist's goal is to help you keep your pain under control, improve your strength and range of motion, and maximize the use of your elbow. When you are well under way, regular visits to the therapist's office will end. Your therapist will continue to be a resource for you, but you will be in charge of doing exercises as part of an ongoing home program.

Elbow Replacement Possible Risks

As with all major surgical procedures, complications can occur. This is not intended to be a complete list of complications. Some of the most common complications following elbow replacement are

• anesthesia
• infection
• loosening
• nerve or blood vessel injury

The major reason that artificial joints eventually fail is that they loosen where the metal or cement meets the bone. A loose joint implant can cause pain. If the pain becomes unbearable, another operation will probably be needed to fix the artificial joint.

There have been great advances in extending the life of artificial joints. However, most implants will eventually loosen and require another surgery. Younger, more active patients have a higher risk of loosening. In the case of an artificial knee joint, you could expect about 12 to 15 years, but artificial elbow joints tend to loosen sooner.

All of the large nerves and blood vessels to the forearm and hand travel across the elbow joint. Because surgery takes place so close to these nerves and vessels, it is possible to injure them during surgery. The result may be temporary if the nerves have been stretched by retractors holding them out of the way during the procedure. It is very uncommon to have permanent injury to either the nerves or the blood vessels, but it is possible.