Elbow Replacement: Types, Procedure, and Recovery

01 April,2024

Joint replacement surgeries have been in practice for over 100 years. In 1925, Robineau conducted the first-ever elbow replacement surgery. Though it was a complicated process in the early days, with the advancements in surgical techniques, the procedure has become more manageable and less risky.
 
An orthopedic surgeon can perform a total elbow replacement or TER. Selecting an experienced surgeon is essential to ensure the best possible outcome. Look for orthopedic surgeons specializing in joint replacement surgeries with extensive elbow replacement experience.

This blog post will discuss what elbow replacement is, how the procedure is performed, the expected results, recovery tips, and associated costs. 

What is Elbow Replacement?

Elbow arthroplasty, also known as elbow replacement, is a surgical procedure to correct abnormalities in the elbow joint. The surgery involves replacing a damaged or deteriorated elbow joint with an artificial one, called a prosthesis.

The main goal of elbow arthroplasty is to restore mobility and improve the functioning of the elbow joint, reducing pain and enhancing the patient's quality of life. The prosthesis may be linked or unlinked. In linked elbow replacement, the hinge connects the implants, while in unlinked elbow replacement, the metal stems are linked through the body's tissue.

What are the Different Types of Elbow Replacement?

Elbow pain can hamper your daily life activities. Understanding the different types available is crucial if you're exploring elbow replacement surgery. Here's a breakdown of the two main options:

Total Elbow Replacement

It is the most common type of elbow replacement. In this procedure, the entire elbow joint, including the damaged parts of the lower arm bone (ulna ) and the upper arm bone (humerus), is replaced with artificial components. These components typically consist of:

• Metal stems: Implanted into the hollow parts of the humerus and ulna.
• Hinge joint: Made of metal and plastic, this mimics the natural movement of the elbow joint.

Advantages:

• More effective for extensive joint damage
• It provides more significant pain relief and improved range of motion

Disadvantages:

• More complex surgery compared to partial replacement
• Longer recovery time
• Risk of loosening or wear of the implant over time (may require revision surgery)

Partial Elbow Replacement (Hemiarthroplasty)

A partial elbow replacement procedure replaces only a part of the elbow joint, typically focusing on the damaged area. It's often used for specific conditions like:

• Severe arthritis isolated to the radial head (one of the forearm bones connecting to the elbow)
• Fractures that cannot heal properly

Advantages:

• Less invasive surgery than TER 
• A shorter recovery time
• It may preserve more natural bone and tissue

Disadvantages:

• Not suitable for all cases of elbow damage
• It may not provide the same level of pain relief and function improvement as a total replacement

Consulting an orthopedic surgeon is essential to discuss your situation and determine the most suitable option. They help explain the pros and cons of each type of replacement and address any questions you may have. The best kind of elbow replacement for you will depend on several factors, including:

• The severity and location of your elbow damage
• Your age and overall health
• Your activity level and desired outcome

Why is Elbow Replacement Done?

Surgeons initially performed total elbow replacement to manage end-stage rheumatic arthritis. However, its uses have broadened with time. Surgeons are now using the procedure to treat conditions such as unfixable comminuted fracture, osteoarthritis, primary or metastatic tumor, hemophilic arthropathy, juvenile idiopathic arthritis, and post-traumatic arthritis.

A joint replacement surgeon recommends an elbow replacement when the bone or cartilage in the elbow joints gets damaged. The damage to the elbow joint reduces the range of motion and causes significant pain. Several diseases and disorders can lead to deteriorating elbow joints. These are:

• Rheumatoid Arthritis (RA): Rheumatoid arthritis of the elbow is a condition in which the immune system attacks the joint's lining, causing pain, stiffness, and swelling. Over time, this can deteriorate the joint and lead to deformity. Elbow replacement surgery is a recommendation for patients with end-stage rheumatoid arthritis who have not responded to other treatments.
• Osteoarthritis (OA): Osteoarthritis of the elbow occurs when the joint's cartilage and other soft tissues are damaged due to injury (dislocation or fracture) or regular wear and tear.
• Post-traumatic Arthritis: In children and adults, injury or trauma to the elbow joint can cause arthritis due to initial soft tissue damage, malunion with the joint surface, or instability. This condition is less common but can require elbow replacement surgery if the damage is extensive.
• Severe Fractures and Chronic Instability: Severe fractures can damage the elbow joint, making it difficult to perform everyday activities. Chronic instability can cause frequent dislocations and may require surgical intervention to restore function. Depending on the extent of the damage, the surgeon may recommend a total or partial elbow replacement.

How to Prepare for Elbow Replacement?

Patients undergo consultations before surgery to evaluate their condition and receive proper instructions for successful results. The visits to the hospital include:

• Initial Discussions: Your doctor will thoroughly evaluate your elbow joint, medical history, and overall health. They will then discuss your expectations, concerns, and medications and outline the surgical plan and potential risks.
• Blood Tests and Imaging: Blood tests assess your overall health, and imaging studies (X-rays, MRIs) provide detailed views of your elbow joint to guide surgical planning.
• Anesthesia Consultation: An anesthesiologist will discuss your anesthesia options (general or regional) and address any concerns you have about anesthesia administration.
• Medication Adjustments: Discuss any medications you take with your doctor, particularly blood thinners or anti-inflammatory medications. They might need adjustments before surgery. 
• Adjustments at Home and Office: An occupational therapist will help you make adjustments at home and office to ease the post-operative period. This includes putting essential and daily-required items on lower shelves, as it would be difficult to reach high shelves. If you don't have anyone to look after you in your initial recovery days, they will recommend you stay at a rehabilitation center. 

How is Total Elbow Replacement Performed?

• For total elbow arthroplasty, an anesthesiologist sedates the patient using general anesthesia and a nerve block.
• Once the patient enters a state of deep sleep, the surgeon makes an incision at the back of the elbow and moves the muscles aside to access the bone.
• The surgeon then prepares the humerus to fit the metallic stem, which will replace that side of the joint. They repeat the same procedure for the ulna bone.
• The surgeon can connect the replacement stems using a hinge (linked) or natural ligaments (unlinked). Only patients without ligament injuries can undergo unlinked elbow replacements.
• Manufacturers usually make the implants used for the TER out of cobalt-chrome alloy or titanium and the implant liner out of polyethylene.
• The surgeon then closes the incision or cut using sutures and places a padded dressing over it to help it heal better.
• The surgeon might also place a drainage tube in the joint to remove surgical fluid.

Recovery After Elbow Replacement

Once the elbow replacement surgery is complete, the hospital staff will take you to the recovery room. The surgical team will prescribe several antibiotics to prevent infection. 

Feeling pain for a few days after a total elbow replacement is normal. The surgeon will advise medications like NSAIDs, opioid analgesics, and local anesthetics for pain management.

You can improve surgical outcomes and speed up your recovery process in several ways. These include – 

• Pre-Habilitation Exercises: Your physical therapist will recommend a few exercises to strengthen the elbow joint muscles. Physiotherapy helps with post-surgical recovery and improves stability. The rehabilitation will include wrist and hand exercises to avoid swelling and stiffness. Keeping the arm elevated will also help reduce inflammation.
• Maintaining Overall Fitness: Continuing your regular exercise routine (as tolerated) can improve your overall health and stamina, which benefits the healing process. As the incision heals, you can perform gentle range-of-motion exercises. However, the patient must wait at least six weeks before putting weight on the arm or pushing against resistance.
• Dietary Considerations: A healthy diet of fruits, vegetables, and lean protein will support the body's healing process. 
• Support System: A reliable support system of friends, family, or caregivers is crucial for emotional well-being and practical assistance during recovery. Ask for help with daily tasks such as bathing, dressing, cooking, and laundry.
• Relaxation Techniques: Try practicing relaxation techniques like meditation or deep breathing to manage anxiety. Anxiety and stress are normal after any significant surgical procedure.

What are the Outcomes of Elbow Replacement?

Recent advances in prosthesis designs and surgery techniques have significantly improved total elbow arthroplasty. The surgery now achieves better and more reliable outcomes than a few decades ago. Over 80% of elbow replacements now last more than ten years. However, choosing renowned orthopedic hospitals with modern medical equipment is crucial for better results.

Recovery from total elbow arthroplasty usually takes 12-15 weeks. You can expect a complete recovery in one year. Once recovered, patients can resume day-to-day activities that were challenging before the surgery. The long-term outcomes of total elbow replacement include:

• Less pain
• Improved quality of life
• A better range of motion
• Better functioning
• An increase in strength

Doctors may advise avoiding activities with a risk of falling (such as horse riding), contact sports (like football), and heavy lifting (limiting weight to 5-10 pounds).

What is the Cost of Elbow Replacement?

The elbow replacement procedure becomes crucial for patients who cannot be managed with medications and physical therapies. However, costs can sometimes be a constraint for such people. Western nations offer elbow replacement surgeries for USD 15,000 to USD 20,000. 

Countries like India offer affordable treatment plans for elbow replacement. The cost of elbow replacement surgery in India is between USD 5,000 and 7,000. It includes preoperative diagnostic tests, the price of the implant, surgery, a hospital stay, physiotherapy, and postoperative costs. 

Outlook

Total elbow replacement is a complicated surgery that requires a well-equipped hospital and a skilled surgeon to achieve positive outcomes. Medications, such as DMARDs, can help control conditions like rheumatoid arthritis that may eventually lead to elbow replacement. However, elbow replacement surgery is often the only option if the disease has progressed. The procedure can significantly improve the patient's range of motion, joint function, and overall quality of life.