Elbow Replacement

Partial Elbow Replacements

Sometimes, the elbow joint is not completely damaged and there are two particular situations that you may not need a complete elbow replacement:

If only the outer part of your joint has arthritis, you may be offered a lateral elbow resurfacing arthroplasty. This is a smaller operation that replaces only the worn outer part of the joint.

In some cases of severe elbow fractures, it is not possible to repair the fracture with plates and screws. In these cases, you may also be offered a half-elbow replacement, something called an elbow hemiarthroplasty.

What does the operation involve?

An elbow replacement is performed under general anaesthetic, usually with a nerve block that helps with your pain for the first day after surgery. It is performed through a cut down the back of your elbow, through which the worn bone is removed and the elbow replacement is inserted.

The whole procedure takes around 2-3 hours to complete. Most people are in hospital for 1-2 days after surgery.

What are the risks and benefits of this operation?

Before agreeing to this procedure, it is important that you are aware of the risks, as well as its benefits. The main benefit, of course, is to relieve elbow pain. The risks of elbow replacement are:

• Infection: Since a cut is made in the skin, like any cut, it can get infected. An infection in the skin is treated with a course of antibiotics. This usually starts 1-2 weeks after surgery, with the surgical wound looking red and sometimes leaking fluid. Sometimes the infection can go deeper into the bone and joint. This requires further surgery to wash the infection out and, in some cases remove the implants. In this situation, it can require a course of antibiotics for several months before putting the elbow replacement back. Infections can happen in approximately 1 in 100 elbow replacements and people with problems with their immune system, or who take medications that reduce your immunity, are at higher risk.We take several measures to reduce the chances of you getting an infection, including using antibiotics at the start of surgery, using antiseptic to clean your skin and performing surgery in a clean environment. It is important to contact your doctor as soon as possible if you elbow becomes more painful, you feel unwell/feverish, or your wound starts to leak.
• Bleeding: Many techniques are used to minimise blood loss. However, with any surgery, there is always a risk of bleeding or damage to blood vessels that can result in bleeding. The risk is kept to a minimum by performing the surgery using a tourniquet, which is a tight band that temporarily stops blood flow to your arm during the operation. If you do have significant bleeding after surgery, you may sometimes require a blood transfusion. It is important to make your doctor aware if you would prefer to avoid a blood transfusion.
• Nerve injury: Nerves are the electrical cables that power the muscles in your arm and give feeling to the skin. Despite taking great care, it is possible to damage nerves around your elbow during this procedure. This would result in a loss of movement or strength in part of your hand or wrist, or a loss of feeling, most commonly around your little finger. It is estimated that around 5-10% of people develop this problem after surgery. It is usually due to the nerve being stretched for part of the operation and for most people, the problem recovers after a few weeks or months.
• Ongoing pain: While elbow replacements are very successful ways of treating the pain in your elbow, with more than 90% of people happy with the result, they do not guarantee complete pain relief. Some people do have ongoing pain and if it is particularly troublesome, your doctor will try to look for a cause.
• Stiffness: Most people with elbow arthritis have limited movement before surgery. Although some people do get more movement after surgery, many people do not. Typically, you can expect to be able to bend your elbow enough to feed yourself using cutlery and get it around 30 degrees off full straightening. Remember, the primary aim of an elbow replacement is to treat the pain and any extra movement you get is a bonus! It is important to work hard with the physiotherapists after surgery to get the best result.
• Dislocation: It is possible that your elbow can come out of joint at any point after surgery. This can sometimes happen if your ligament repair does not heal. It is therefore important to follow your physiotherapist's advice to ensure that you are giving the ligaments around your elbow a chance to heal without damaging them. An operation is usually required if your elbow dislocates to put it back in joint because it can be a painful condition. If it dislocated repeatedly, further surgery may be offered to try to prevent this.
• Loosening and wear: Like any mechanical item, an elbow replacement can loosen from the bone or wear out over time. If this happens, it can become painful again. You may be offered further revision surgery to put in a new elbow replacement. Around 80-90% of elbow replacements last 10 years or more.
• Fracture: As part of the operation, it is possible to break the bone, especially if your bone is unusually weak. Furthermore, if you fall at any time after the operation, there is a risk of fracture too. These of course will be treated as required by your surgeon.
• Risks of Anaesthetic: Before your operation, you will have your preop health checkup. Serious problems related to the anaesthetic are very rare (less than 1 in 10,000 for healthy people), but can be serious and sometimes life-threatening. These problems may include heart attack or a stroke, which can affect the movement of any part of your body, speech problems or even blindness. With any surgery, there is also a risk of a blood clot in your leg (DVT / deep vein thrombosis) or lung (PE / pulmonary embolism) and some people are given blood-thinning medications if their risk is higher. Your anaesthetist and surgeon can discuss your own personal risks and the measures they take to keep you as safe as possible throughout surgery.

What is the recovery after this surgery?

You will be provided with a sling after surgery, along with instructions from the physiotherapist about how to put on and take off the sling. You are usually advised to use the sling for 3 weeks to allow healing to start, but can wean yourself off the sling over the next 3 weeks. Most people have little or no pain immediately after surgery due to the nerve block that the anaesthetist puts in. It is vitally important that you start taking painkillers supplied to you before the nerve block wears off so that you keep on top of any pain when the block wears off. Some people also find an ice pack helpful in the first few days. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.

Your physiotherapist will give you some exercises to start. It is important that you do these exercises to prevent stiffness and maximise your chance of a good recovery. Most people are allowed to gently use their elbow straight away, within the limits of pain. You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK. You will notice your elbow improving over the next few months, but it can take up to a year of work with your physiotherapist to get the full benefit of surgery.