Information on elbow replacement and some frequently asked questions
Elbow replacement
The elbow is a hinge joint made up of three bones, which are connected by muscles, ligaments and tendons. These bones are:
- the humerus, which is the upper arm bone
- the ulna, which is the inner forearm bone
- the radius, which is the outer forearm bone
What is an elbow replacement?
An elbow replacement, often referred to as an elbow implant or an implant device is, in basic terms, an artificial implant that replaces an elbow joint that is damaged.
Joint replacements are carried out because of pain that cannot be controlled by other methods such as painkillers, physiotherapy or other surgery, or for the management of fractures of the bones around the elbow. The most common cause of pain needing elbow replacement is inflammatory arthritis.
A total elbow replacement is made up of metal and plastic parts and replaces the joint between the humerus (upper arm bone) and ulna (inner forearm bone). There are two metal stems that fit into the bone cavity of the upper and lower arm and these are usually fixed into place by using bone cement. The two metal stems are either linked (like a hinge) or unlinked, depending on the type of replacement.
Ask your specialist about what elbow replacement they recommend and what the advantages and disadvantages of it are.
Types of elbow replacement and implants used
A lateral resurfacing procedure is the replacement of part of the elbow joint, on the outer side of the arm. Only part of the upper arm bone (humerus) and, if required, the top of the outer forearm bone (radius) are replaced with a metal and plastic joint.
For all procedures, different sizes of components are available to aid the surgeon in finding the most suitable ‘fit’ for the patient.
TA radial head replacement is made up of a short metal stem and a highly polished metal, carbon or plastic head. The component replaces the top of the outer forearm bone (radius) and moves against the ends of the patient’s own upper arm and inner forearm bones.
A lateral resurfacing procedure is the replacement of part of the elbow joint,
on the outer side of the arm. Only part of the upper arm bone (humerus) and, if
required, the top of the outer forearm bone (radius) are replaced with a metal and plastic joint.
For all procedures, different sizes of components are available to aid the surgeon in finding the most suitable ‘fit’ for the patient.
Surgical technique
During a primary elbow replacement, bone grafting may be required to stabilise the joint and implant.
Measures to prevent blood clots
The type of prevention offered to patients varies, depending on their risk factors, for eg. previous experience of a blood clot in leg veins. There are two main types – chemical and mechanical: the most common mechanical is TED (anti-embolism) stockings and the use of intermittent calf compressions; in the use of chemical treatment the most common regime was low molecular weight Heparin.
Many procedures make use of both chemical and mechanical prevention methods
About revision elbow replacements
Over time, implants can wear and need to be revised, often due to loss of function or pain – commonly known as revision or re-do procedures.
The NJR records operation information and patient details (by consent) to measure the length of time an implant lasts. This is to ensure that if any implants fail earlier than expected, it can be picked up and the information acted upon.
Thinking about your treatment options
Joint replacement is a highly successful operation that can bring relief from pain and improve mobility. However, going through the process can be baffling and many patients do not always understand their options or the detail of their treatment plan. It is important you feel supported by your surgeon when discussing your available options.
Working together with your practitioner is known as shared decision-making.
Shared decision-making recognises all the different factors in your life that will lead to better quality decisions, from your surgeon’s advice, through to the support from your family and friends.
Sources such as this National Joint Registry information should make you feel confident in asking questions about your surgery, your implant and your recovery. There are some commonly-asked questions below. You may wish to write these out and make some notes.
Whatever the reason for your joint replacement, there are many others going through the same process, and it may help to know you are not alone. There is additional support out there for you on shared decision-making as well as advice on looking after yourself before and after surgery.
FAQs
As you make plans for your joint replacement surgery it may be helpful for you to make a note of any questions or queries you may have either for your surgeon or clinical team at the hospital. Some commonly asked questions are:
- Do I need joint replacement surgery? Are there other options available to me?
- If I do, how should I prepare for surgery?
- What type of implant are you recommending? What are the pros and cons?..
- What surgical technique would be used? What are the pros and cons?
- What should I know about my aftercare?
- What do I need to think about when I return home after my operation?
Further information about shoulder replacement
There are many organisations that provide additional general information about elbow joint replacement, including specific guidance before and after surgery, as well as online discussion forums. Please see links here for some of these, such as: patient groups including Versus Arthritis; and the British Elbow and Shoulder Society (BESS) who all have further useful advice.