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Total Elbow Replacement

Elbow Joint Replacement, also referred to as Total Elbow Arthroplasty is an operative procedure to treat the symptoms of arthritis that have not responded to non-surgical treatments.

elbow is made up of three bones that join to form a hinge joint. The upper arm bone or humerus connects from the shoulder to the elbow forming the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain free movement in the joint. This surface can wear out for several reasons. Often the definite cause is unknown.

When the articular cartilage wears out, the bone ends rub on one another causing pain. In general, but not always, arthritis affects people as they get older.

Indications

Elbow joint replacement surgery may be recommended by Professor Bain for the treatment of severe arthritis that has not responded to conservative treatment options such as medications or steroid injections.

Other indications for elbow joint replacement surgery may include:

  • Severe elbow fracture in older patients with osteoporosis
  • Tumour or growth in the elbow joint
  • Pain despite previous elbow surgery

Diagnosis

Your elbow conditions should be evaluated for a proper diagnosis and treatment. Professor Bain will perform the following:

  • Medical History
  • Physical Examination

Tests will include X-ray's and possibly CT or MRI scan.

Surgical Procedure

Elbow joint replacement surgery is an option that Professor Bain may recommend if your overall health is good and you have not had success with conservative treatments options.

The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint. The surgery is performed under sterile conditions in an operating room under general or regional anaesthesia and involves the following steps:

  • An incision is made over the back of the elbow.
  • The muscles are retracted and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.
  • The damaged joint surfaces of the humerus, radius and ulna are cut off with a surgical saw to create a smooth surface to attach the implants.
  • A special instrument is used to hollow out the inside of the humerus bone to insert the humeral component of the prosthesis.
  • This procedure on the ulna bone to prepare it for the ulnar component of the prosthesis.
  • The humerus and ulna bones are then prepared and usually cemented into position.
  • With all the new components in place, the joint is tested through its range of motion.
  • The new joint is irrigated with sterile saline.
  • The joint capsule, soft tissues and skin are sutured..
  • The elbow is then dressed and bandaged. A splint may be used.

Post-Operative Care

After surgery, you will be given guidelines on how to mobilise the elbow.

Common Post-operative guidelines include:

  • You will probably stay in the hospital 1-3 days after the surgery.
  • Your pain will be managed with analgesia injections and tablets.
  • Your arm will be in a sling or splint with a bulky dressing
  • Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.
  • Occupational Therapy (OT) will begin soon after surgery and continue for about 3 months to regain range of motion of the elbow joint.
  • Sutures are usually dissolvable.
  • Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by Professor Bain.
  • You will be given specific instructions regarding activity and rehabilitation.
  • Eating a healthy diet and not smoking will promote healing.

Risks and Complications

Most patients suffer no complications following Elbow Joint Replacement, however, complications can occur following elbow surgery and include:

  • Infection
  • Fractures of the humerus or ulna bone
  • Dislocation of the elbow
  • Damage to nerves of blood vessels
  • Blood clots (Deep Venous Thrombosis
  • Loosening of artificial components
  • Wound irritation
  • Failure to relieve pain

If following the surgery you have any wound problems or pain, you should contact Professor Bain that day.