Elbow Replacement

Relieving Elbow Pain and Restoring Motion

What is Elbow Replacement Surgery?

Elbow replacement, also referred to as elbow arthroplasty, is a complicate procedure given the elbow has several moving parts that balance each other to enable precise control when moving the forearm. Elbow replacement surgery involves the removal of the damaged elbow joint with an artificial joint made from two implants that are joined together by a metal and plastic hinge with two metal stems.

Anatomy of the Elbow

The elbow is a hinge comprising of three bones; the humerus (upper arm bone), the ulna (forearm bone on the pinky finger side) and the radius (forearm bone on the thumb side).

The ends of the bones are covered with articular cartilage, a smooth substance that protects the bones and enables the elbow joint to slide easily. The bones are held together with ligaments that form the joint capsule. A thin, smooth tissue called the synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.

All of the nerves that travel down the arm pass across the elbow. Three main nerves begin together at the shoulder — the radial nerve, the ulnar nerve and the medial nerve. These nerves are responsible for signaling your muscles to work and to also relay sensations such as touch, pain and temperature.

Elbow Arthritis

Arthritis can happen at any joint and the elbow is no exception. When your arthritic symptoms lead to severe pain, inflammation and stiffness, leading to bending and straightening the elbow, your orthopedic elbow surgeon may recommend elbow replacement surgery to replace the damaged elbow joint to treat your elbow pain and swelling.

Elbow arthritis happens over time, when the smooth cartilage on the surface of the bones wears away and the worn cartilage no longer serves as a cushion. As the roughened bones rub together, they eventually wear away at each other causing inflammation and pain that spreads to the surrounding soft tissue structures. The elbow can become warm, swollen, and tender to touch. When severe it becomes difficult to daily activities.

Symptoms of elbow arthritis:

• Pain
• Swelling
• Instability
• Lack of range of motion
• Locking
• Elbow stiffness
• Bilateral elbow pain

Common Reasons for Elbow Replacement

Several elbow conditions can cause elbow pain or limited function, leading patients and their elbow doctors to consider elbow replacement surgery.

• Osteoarthritis is an age-related “wear and tear” of the elbow joint. It usually occurs in people aged 50 years and older with a family history of arthritis, but may occur in younger patients too. The cartilage that cushions the bones of the elbow joint softens and wears away. The bones then rub against each other, causing the elbow joint to stiffen and become painful.
• Rheumatoid Arthritis is an autoimmune disease in which the synovial membrane that surrounds the elbow joint becomes inflamed and thickened, producing too much synovial fluid, which overfills the joint space. This results in chronic inflammation that can damage the cartilage and eventually cause cartilage loss, pain and stiffness.
• Post-traumatic Arthritis can follow a serious elbow injury. Fractures of the bones that make up the elbow, or severe trauma to the surrounding tendons and ligaments may damage the articular cartilage over time, causing elbow pain and limiting function.
• Severe Fractures of one or more bones that make up the elbow is another common reason a patient may have elbow replacement surgery. If the elbow is shattered, it may be difficult for a doctor to put the bone back in place and the blood supply to the area can be disrupted. Distal Humerus Fractureis a growing cause for needing elbow replacement surgery. The upper arm bone can break due to trauma or weaker bones caused by osteoporosis in older patients. In older patients the bone quality may not be good enough for traditional methods used to fix a broken bone.
• Elbow Instability occurs when the ligaments that hold the elbow joint together are damaged and no longer work well. The elbow is prone to dislocation. Chronic instability is most often caused by an injury.

Understanding Limitations After Elbow Replacement

Like other prosthesis including the knee, hip, shoulder, or ankle; undergoing elbow replacement does have its limits. However, it is a great solution for most patients with severe arthritis and pain who want to maintain movement and motion of their elbow. The main limitation of elbow replacement surgery is the permanent lifting restriction of not more than seven pounds. Elbow replacement surgery is generally recommended for healthy people over the age of 60 who don’t need to lift heavy items.

Types of Elbow Replacement Surgery

Elbow replacement surgery is a common surgical procedure used in the management of advanced rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, severe fractures and elbow instability. The prostheses continue to evolve and improve. Below we explain the different types of elbow replacement procedures available at Newport Orthopedic Institute.

Partial Elbow Replacement is used when the patient only needs one portion of the joint to be replaced. For example, if only the head of one of the forearm bones (radius) is damaged, it can be replaced with an artificial head.

Total Elbow Replacement Surgery involves the removal of damaged parts of the humerus and ulna and replacement with artificial implants. There are different types of elbow replacements and implant components come in different sizes to account for different needs of our patients. Your elbow surgeon will help to determine what type of elbow replacement is best for you.

Total elbow replacement can be done two ways – linked and unlinked. In the U.S. the linked implant is more common.

• Linked: A metallic stem is anchored inside the humerus (upper arm bone) and another is inserted in the ulna (one of the two bones in the forearm). They are then cemented in place. The two stems are connected with a hinge made of metal and plastic. This type of prosthesis acts somewhat like a loose hinge because all of the parts of the replacement joint are connected. Sometimes, however, the stress of movement can result in the prosthesis stretching and causing the implant to loosen. Hence the reason for the restriction against lifting anything too heavy.

• Unlinked: With an unlinked implant, the device comes in two separate pieces that are not connected to each other (one in the humerus and the other in the ulna), but without a hinge. The design depends on the surrounding ligaments, muscles, and other structures of the elbow to help hold the joint together, which can make it more prone to dislocation. These tissues must be in good condition for this to work well. Otherwise, it can become unstable. Physical therapy to strengthen the muscles and ligaments is critical for the best long-term results and joint stability.

Revision Elbow Replacement Surgery may be needed if the elbow replacement implants become worn or loose requiring replacement. If this is the case, the artificial joint will be removed and replaced with a new artificial elbow joint. Newport Orthopedic Institute’s elbow surgeons are trained to perform revisions and corrections of failed elbow replacement surgeries.

Are you a candidate for Elbow Replacement Surgery?
Call Newport Orthopedic Institute for a consultation at (949) 722-7038.