Overview
Elbow replacement involves surgically replacing bones that make up the elbow joint with artificial elbow joint parts (prosthetic components). The artificial joint consists of two stems made of high-quality metal. They are joined together with a metal and plastic hinge that allows the artificial elbow joint to bend. The artificial joints come in different sizes to fit the patient.
The elbow is a hinge joint consisting of three bones. The upper part of the hinge is at the end of the upper arm bone (humerus), and the lower part of the hinge is at the top of the two forearm bones (radius and ulna) which are side by side. When the elbow is bent, the ends of the two forearm bones rub against the end of the humerus.
Anatomy
How does the elbow joint work?
The elbow joint is made up of three bones the humerus bone of the upper arm, and the ulna and radius bones of the forearm.
The ulna and the humerus meet at the elbow and form a hinge. This hinge allows the arm to straighten and bend. The large triceps muscle in the back of the arm attaches to the point of the ulna (the olecranon). When this muscle contracts, it straightens out the elbow. The biceps muscles in the front of the arm contracts to bend the elbow.
Inside the elbow joint, the bones are covered with articular cartilage. Articular cartilage is a slick, smooth material. It protects the bone ends from friction when they rub together as the elbow moves. Articular cartilage is soft enough to act as a shock absorber. It is also tough enough to last a lifetime, if it is not injured.
The connection of the radius to the humerus allows rotation of the forearm. The upper end of the radius is round. This round end turns against the ulna and the humerus as the forearm and hand turn from palm down (pronation) to palm up supination).
Indications
Your physician may determine that an elbow replacement is appropriate if you have one or more of the following conditions:
- Bone injury or bone loss contributing to elbow instability
- Abnormal stiffness, immobility, and consolidation of the elbow joint (ankylosis)
- Painful deterioration of the elbow joint cartilage (osteoarthritis)
- Painful inflammation in the lining of the elbow joint (rheumatoid arthritis)
- Arthritis resulting from physical injury to the elbow joint (traumatic arthritis)
- Elbow joint instability or loss of motion, which cannot be satisfactorily addressed by more conservative treatment options
- A previous elbow joint replacement, which has worn or failed.
Total Elbow Replacement Surgery
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.
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 Fusion
A fusion surgery (also called arthrodesis) eliminates pain by making the bones of the joint grow together, or fuse, into one solid bone. Fusions were very common before the invention of artificial joints. Even today, joint fusions are commonly used in many different joints to get rid of the pain of arthritis.
An elbow fusion will greatly decrease the motion in your arm. However, it does leave you with a strong and pain-free elbow. People who need a good range of motion in their elbow should consider another type of operation, such as an elbow joint replacement.
After Surgery
Your elbow will be bandaged with a well-padded dressing and an elbow splint for support. Physical or occupational therapy sessions may be needed for up to three months after surgery. The first few treatment sessions will focus on controlling the pain and swelling from surgery. You will then begin to do exercises that help strengthen and stabilize the muscles around the elbow joint. Your therapist will give you tips on ways to do your activities without straining your elbow.
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