Total elbow replacement surgery has advanced considerably since its modern development in the 1970s. Elbow replacement is much less common than total hip or knee replacement. The purpose of this type of surgery is to lessen pain and to restore functional ability of the elbow.
Development of pain and loss of mobility may develop for a number of reasons. Osteoarthritis of the elbow refers to age related degeneration in which the normal joint cartilage wears, resulting in bone rubbing against bone. In rheumatoid arthritis, the elbow joint becomes stiff from inflammation and thickening of the surrounding tissues leading to chronic changes and pain. Arthritic changes can also develop within the elbow from a traumatic injury. Similarly, the joint surfaces may be permanently disrupted following a fracture or from prior surgeries.
The diagnosis is usually made by an orthopaedic surgeon based on physical examination and review of x-ray studies. Some patients who fail non-surgical options may be a candidate for total elbow replacement. This complex procedure is normally performed by a highly trained and experienced orthopaedic surgeon. A patient must have sufficient bone quality and stability of the supporting structures for this to be successful. Also, the general health, normal activity level, and motivation of the patient are important considerations.
There are different options available for the prosthesis that is used. Commonly known as a constrained device, a metal and plastic hinged elbow joint can be placed into the humerus and ulna which make up the elbow joint. The components come in different sizes and are made of different types of metals.
An unconstrained option also exists. This amounts to a resurfacing of the joint and placement of a prosthesis. One of the major concerns with this approach is eventual loosening of the components which rely heavily on ligamentous support. The constrained approach, with a hinged joint does not rely on support from the ligaments.
This type of surgery is performed at a hospital setting under general anesthesia. A nerve block may also be performed to reduce post-surgical pain. The procedure can take up to a few hours to perform. The normal hospital stay is one to three days following surgery.
A total elbow replacement can be very effective at alleviating pain and improving mobility. Complete resolution of discomfort, stiffness and range of motion may not be possible.
Complications from this type of surgery are relatively low. Unfortunately, some of the potential complications can delay or prevent a full recovery from this type of surgery. A superficial or deep wound infection, fracture of the surrounding bone, dislocation of the prosthesis, device failure, blood clots and other major medical complications such as heart attack and stroke can occur. These complications may appear early after surgery or years later.