Elbow joint replacement is not a common procedure. The main indication for total elbow joint replacement is pain that cannot be adequately controlled by painkillers and anti-inflammatories.
In cases of severe degenerative changes in the elbow joint, a prosthesis can be inserted to provide a new hinge mechanism. Compared to other joint replacements in the body, elbow replacements have a shorter lifespan.
The forces across the joint are considerable and over time, the prosthesis may gradually wear out. Often the implants will loosen slightly due to normal loading forces. Because of the risk of loosening and early wear and tear on the joint, these implants are best suited for patients with low demand physical activities.
Patients are usually advised to avoid lifting tasks with the treated arm. This procedure is therefore not suited for younger patients who want to return to heavier physical activities.
The operation is performed under a general anaesthetic. A long incision is made on the back of the elbow. Then a slither of bone is removed from the olecranon process with detachment of the triceps tendon insertion. This allows access to the joint surface.
The joint surfaces are resected using cutting guides which allow clean and precise shaping of the end the joint. Metallic prosthetic components are inserted with a polyethylene lining surface.
The ulnar nerve is in close proximity to the surgical zone and has to be released and protected. The triceps tendon is reattached at the end of the operation. This needs to be protected in the first few weeks after surgery as it heals.
Even with a joint replacement, patients will still have some restriction in the range of movement. They may lack the end range of their extension and flexion. The aim of surgery is to restore a functional range of movement that is comfortable.
As always, there is a risk of infection with surgery. There is also potential for some swelling around the nerves that can result in altered quality of sensation in the hand.