Shoulder & Elbow : Total Elbow Replacement

What is total elbow replacement?

The elbow joint is made up of three bones - the humerus, ulna and radius, which join together at the elbow to form a “hinge” joint. The humerus is the bone in the upper arm, and the ulna and radius are the bones in the forearm. A total elbow replacement is an operation which replaces the worn surfaces of the humerus and ulna with new surfaces.

How is the operation carried out?

An elbow replacement is carried out under a general anaesthetic. It involves an incision along the back of your elbow and will leave a scar about 15cm long.

What are the benefits of having a total elbow replacement?

A total elbow replacement is used for people who have significant pain in the elbow and reduced elbow movement because of severe degenerative changes in the elbow, such as arthritis.

Rheumatoid Arthritis is the main reason why elbow replacements are carried out. This is a type of arthritis that can affect many joints in the body resulting in pain and reduced movement.

Osteoarthritis is "wear and tear" arthritis which damages the joint surfaces. Occasionally an elbow replacement may be carried out following trauma to the elbow which has resulted in fractures involving the joint surfaces. It is normal to experience some pain after the operation but a total elbow replacement can relieve a lot of the pain you have previously experienced. In addition there may be some improvement in the range of movement of your elbow. It is unlikely you will get as much movement as in a normal elbow but due to the decreased pain you may be able to carry out functional activities more easily.

Are there any complications of having a total elbow replacement?

As with most types of surgery there are risks involved and complications can occur unrelated to the elbow replacement.

These include:

  • Anaesthetic risks

  • Chest infections

  • Blood clots in the legs (deep vein thrombosis)

  • Blood clots in the lungs (pulmonary embolus)

Some other complications, which can occur specifically following an elbow replacement, are:

1) Infection
2) The new joint loosening
3) Damage to the nerves
4) Fracture

These risks are very small but if any occur, further treatment or an operation may be necessary.

1) Infection can be a serious complication. Some infections show up immediately whilst you are still in hospital, others are not obvious until you have gone home. To try and reduce this risk, it is normal practice to give antibiotics at the time of your operation.

2) Loosening is one of the main reasons why joint replacements can eventually fail. On average you can expect your elbow replacement to last at least 5 years and hopefully more than 10 years before there is any significant loosening.

3) Nerve damage can occur during the surgery as nerves pass close by the site of the operation. Damage can be temporary if retractors holding them out of the way stretch them. This could result in some reduced feeling or weakness in part of your hand making it difficult for you to use your hand. It is rare that permanent damage can occur, but is possible.

4) A fracture during surgery is very rare, but may require additional surgery or a slightly different prosthesis. There is a small risk of a peri-prosthetic (below the
metal work) fracture after surgery - this is most likely to occur if you fall.

What happens if I agree to a total elbow replacement?

If you and your surgeon agree that a total elbow replacement is necessary, you will be asked to attend a pre-assessment clinic a few weeks before your surgery to ensure you are fit for the operation. This allows the team to record some baseline information such as your blood

During your clinic appointment, the pre-operative assessment nurse will discuss your stay in hospital and organise any other necessary tests. These may include a blood test, urine test, an ECG (heart tracing) and x-rays.

If you feel that you may need extra support or help at home following your operation, please mention it at this clinic appointment. Another purpose of this clinic is for you to ask any
questions about the forthcoming surgery.

When will I know the date of my operation?

You may be given a provisional date at pre-assessment clinic and this will be confirmed by letter.

What instructions will I be given before my operation?

You will receive a letter which will confirm your admission date and it will include specific instructions you need to follow before coming in to hospital. If you take regular medication you will be told at preassessment clinic whether you should continue taking it as normal.

How long will I be in hospital for?

Following an elbow replacement you will generally be expected to remain in hospital up to a further 5 days. This is to ensure you are fit and well enough to manage at home, and also to start your post-operative rehabilitation.

Will I have to wear a sling?

For the first few days after the operation your elbow will be held straight in a plaster cast. When the cast is removed then you may be given a sling for a few days for comfort. You will be shown how to remove the sling carefully to wash and dress.

How will I sleep?

Sleep may be a little uncomfortable if you try and sleep on your affected side; we recommend that you lie on your back or on your opposite side as you prefer. Pillows can be used to give you comfort and support (feather pillows are easier to mould than foam ones).

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