Elbow Replacement

An elbow replacement removes a damaged elbow joint and replaces it with an artificial joint called a prosthesis. Your surgeon may recommend this surgery if your elbow is severely damaged by arthritis, injury or infection. Elbow replacement is also called elbow arthroplasty or elbow joint replacement. It can restore pain-free range of motion and elbow function.

Your elbow joint is made up of three bones: the upper arm bone (humerus), the lower arm bone on the thumb side (radius), and the lower arm bone on the pinky side (ulna). The humerus and the ulna meet to form a hinge joint that allows your arm to bend and straighten. The way the humerus and radius connect allows the lower arm to rotate between the palm-up and palm-down positions.

Elbow replacement is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment options before having an elbow replacement. 

Your doctor may recommend elbow replacement to treat serious elbow damage when symptoms are severe or restrictive. Symptoms include severe pain, deformity or disability, including elbow weakness and instability. 

Your doctor may only consider elbow replacement if less invasive treatments do not improve pain and elbow function. Ask your doctor about all of your treatment options and consider getting a second opinion.

Elbow replacement treats severe or permanent elbow joint damage due to: 

• Elbow joint injuries, including severe fractures, torn ligaments, and torn cartilage
  
  
• Inflammatory forms of arthritis, including rheumatoid arthritis
  
  
• Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones
  
  
• Post-traumatic arthritis, which is arthritis that develops following a serious injury

Orthopedic surgeons and hand surgeons perform elbow replacement.  Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments.  Hand surgeons are orthopedic or plastic surgeons who further specialize in surgery of the hand, wrist, forearm and elbow.

Your elbow replacement will be performed in a hospital. It involves a six-inch incision in the back of the elbow to remove the damaged bones. This includes the lower end of the humerus and the upper end of the ulna. Your surgeon shapes and prepares the remaining bone to hold the new joint. Your surgeon then places an artificial elbow joint made of metal and plastic, tests the new joint, and secures it permanently in place.

Types of anesthesia 

Your surgeon will perform your elbow replacement using either general anesthesia or regional anesthesia. 

• General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
  
  
• Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
  
  

What to expect the day of your elbow replacement

The day of your surgery, you can expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  
  
• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
  
  
• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
  
  
• A surgical team member will start an IV.
  
  
• The anesthesiologist or nurse anesthetist will start your anesthesia.
  
  
• A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
  
  
• The surgical team will monitor your vital signs and critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
  
  

As with all surgeries, elbow replacement involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

• Anesthesia reaction, such as an allergic reaction and problems with breathing
  
  
• Bleeding, which can lead to shock
  
  
• Blood clot 
  
  
• Infection 
  

Potential complications of elbow replacement

Problems with elbow replacement are not common but include:

• Breakage or fracture of the new joint
  
  
• Failure or weakness of the triceps tendon
  
  
• Loosening of the new joint causing pain and possibly requiring additional surgery to secure it
  
  
• Nerve, muscle, bone, or blood vessel damage
  
  
• Ongoing elbow stiffness and pain
  
  
• Wear and tear or loosening of the new joint requiring another replacement
  
  

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.
  
  
• Informing your doctor if you are nursing or there is any possibility of pregnancy
  
  
• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
  
  
• Taking your medications exactly as directed
  
  
• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for elbow replacement by:

• Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
  
  
• Arranging for a ride home after hospital discharge. It is also a good idea to have someone stay with you for the first 24 hours.
  
  
• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
  
  
• Losing excess weight before the surgery through a healthy diet and exercise plan
  
  
• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
  
  
• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
  
  
• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
  
  

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need elbow replacement? Are there any other options for treating my condition?
  
  
• If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
  
  
• How long will the procedure take? When can I go home?
  
  
• What restrictions will I have after the surgery? When can I return to work and other activities?
  
  
• When will I start physical therapy? Where do I go for it?
  
  
• What kind of assistance will I need at home?
  
  
• What medications will I need before and after the surgery? How should I take my medications?
  
  
• How will you treat my pain?
  
  
• When should I follow up with you?
  
  
• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect can help make your road to recovery after elbow replacement as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. 

You will likely stay in the hospital for two to four days. If you live alone, you may need to stay in a rehabilitation center after discharge from the hospital. Rehabilitation will help you improve your mobility and joint function so you can safely return home. Other options include home care support.

You will likely wear a soft elbow splint or sling for a few weeks. After two weeks, you may only need the splint or sling at night or during certain activities. You will have physical therapy to help you recover and regain elbow strength and movement. Your surgeon or therapist will tell you when it is safe to return to your normal activities.

Recovery after surgery is a gradual process. Recovery time varies depending on the type of anesthesia, your general health, your age, and other factors. Full recovery takes up to three months.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after elbow replacement. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding
  
  
• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
  
  
• Change in alertness, such as passing out, unresponsiveness, or confusion
  
  
• Chest pain, chest tightness, chest pressure, or palpitations
  
  
• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
  
  
• Inability to urinate or have a bowel movement
  
  
• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
  
  
• Numbness or tingling in the affected arm or hand
  
  
• Pain that is not controlled by your pain medication
  
  
• Unexpected drainage, pus, redness or swelling of your incision
  
  

How might elbow replacement affect my everyday life?

Elbow replacement may reduce your symptoms and improve elbow function so you can lead an active, normal life. Elbow replacement can help you to be more independent and return to normal daily activities, such as cooking and dressing yourself.

You will need to protect your new elbow joint by avoiding:

• Contact sports
  
  
• Falls and activities with a high risk of falls such as climbing a ladder
  
  
• High impact activities such as hammering and chopping wood
  
  
• Joint overloading activities such as lifting anything over five to 10 pounds