Elbow Replacement
The ends of the bones that form the elbow joint are covered with articular cartilage, a smooth material that protects the bones and allows them to move easily.
The rest of the surfaces inside the elbow are lined with a thin tissue called the synovial membrane. In a healthy elbow, this membrane produces a small amount of fluid that lubricates the joint, helping the bones glide smoothly and reducing friction when you bend or rotate your arm.
The elbow is a hinge joint made up of three bones:
- The humerus (upper arm bone)
- The ulna (forearm bone)
- The radius (forearm bone)
The ends of the bones that form the elbow joint are covered with articular cartilage, a smooth material that protects the bones and allows them to move easily. The rest of the joint surfaces are lined with a thin tissue called the synovial membrane, which produces a small amount of fluid to lubricate the joint and reduce friction when you bend or rotate your arm. Muscles, ligaments, and tendons hold the elbow joint together and provide stability.
Elbow joint replacement (also called elbow arthroplasty) is an effective treatment for problems caused by elbow arthritis. It is also increasingly used in older adults to replace joints damaged by fractures. More than 90 percent of patients who undergo elbow replacement report a successful outcome with reduced pain and improved joint function.
Indications
- Rheumatoid arthritis (RA)
- Primary osteoarthritis (advanced)
- Un-reconstructable Fracture
- Chronic instability
Preparing for Surgery
As with all surgeries, there are a number of things that the hospital will ask you to do to contribute to the success of the operation.
- Choose the right doctor
- Understand the procedure well -educate yourself
- Keep all your past medical records handy and assemble all the documents and other things required on admission, during the stay in the hospital and for discharge.
- Pre-operative fitness tests are done, medical clearance is obtained (sugar levels and BP is maintained in normal range),a few medications like blood thinners are generally stopped before surgery.
- If you have any questions or concerns, ask your doctor or hospital staff.
Your doctor may want you to meet the Physical Therapist (PT) before surgery
Home Planning
Making simple changes in your home before surgery can make your recovery period easier.
For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterward on low shelves.
Surgery
In most total elbow replacement surgeries, general anesthesia is preferred.
In total elbow replacement surgery, the damaged parts of the humerus and ulna are replaced with artificial components.
Type of implant
Linked/Coupled Implant
The implant is the physical linking of the humeral and ulnar components at the time of surgery in order to prevent dislocation episodes. Newer-designed implants allow a decent range of motion at the elbow and do not wear out fast. These humeral and ulnar implants are made of titanium/chrome cobalt alloy fixed together with an axis pin and have to be fixed in bone using bone cement.
Example of implant used to replace the elbow joint:
- Coonrad-Morrey Linked Semiconstrained Elbow Arthroplasty
- Linked implants ensure joint stability, even in the presence of severe bone loss or ligamentous insufficiency which allows more reliable restoration of elbow motion.
PHYSIOTHERAPY PROTOCOL
1-4 weeks
Gentle strengthening exercises for the muscles around the elbow, hand, and shoulder are recommended.
Physiotherapy will include:
- Cryotherapy (Ice)
- Use of sling when out and about for protection (not necessary all the time)
- Passive range of movement exercises for elbow and wrist (bending, straightening, twisting)
- Progression to active range of movement exercises
- Stretching exercises to increase flexibility
5-8 weeks
- Active Range of movement exercises (bending, straightening, and twisting elbow joint)
- Strengthening, stretching, and range of movement exercises for shoulder
Full recovery after total elbow replacement may take up to 1 to 3 months.
The majority of patients have experienced an improved quality of life after total elbow replacement surgery. They experience less pain, improved motion and strength, and better function. The success and rate of recovery highly depend on your commitment and adherence to the comprehensive physiotherapy program apart from a good surgical procedure.