Total elbow joint replacement for elbow arthritis: Surgery with a dependable, time-tested prosthesis can lessen pain and improve function in elbows, especially in rheumatoid arthritis of the elbow
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, October 28, 2009
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Considering surgery
Types of surgery recommended
Joint replacement surgery is the most effective method for restoring
comfort and function to elbows damaged by severe rheumatoid arthritis.
When the normally smooth surfaces of the elbow joint are severely
damaged by rheumatoid arthritis, elbow joint replacement arthroplasty
may be the most effective method for restoring comfort and function to
the joint. Other surgical options, such as arthroscopy or "clean up"
operations have not been shown to give lasting benefit. Elbow fusion
can stabilize the joint, but does not allow motion at the elbow joint.
Removing the joint allows some motion at the joint, but does not
provide stability.
Several types of surgery have been used to manage arthritis of the
elbow. If the arthritis primarily affects the joint between the lower
end of the humerus (upper arm bone) and the head of the radius (one of
the forearm bones), removal of the head of the radius may restore
comfort and function to the elbow.
Joint replacement of the elbow may be of the constrained (hinge) or
unconstrained (joint resurfacing) types. In the treatment of severe
rheumatoid arthritis of the elbow, the constrained (or hinge) joint
replacement is often preferred because it offers stability to the joint
and is not dependent on ligaments, which may be weakened by the
arthritis.
Who should consider elbow replacement surgery?
Joint replacement surgery is considered when:
- the arthritis is a major problem for the patient,
- the patient is sufficiently healthy to undergo the procedure,
- the patient understands and accepts the risks and alternatives,
- there is sufficient bone and tendon to permit the surgery, and
- the surgeon is experienced in elbow replacement surgery.
Total elbow replacement is most effective when the patient follows a simple exercise program after surgery.
Effectiveness
In the hands of an experienced surgeon, total elbow joint replacement
arthroplasty can be very effective in restoring comfort and function to
the elbow of a well-motivated patient. The greatest benefits are often
the ability to sleep on the affected arm and the ability to perform
usual activities of daily living. As long as the elbow is cared for
properly and subsequent injuries are avoided, the benefit can last for
decades.Urgency
In general, this surgery is elective, and can be performed when
conditions are optimal. Sometimes the pain and stiffness from elbow
arthritis will stabilize at a level that is acceptable to the patient.
However, in rheumatoid arthritis, progression of the condition may
result in loss of the tendon and bone, making the surgery more
difficult for the patient and for the surgeon.
Because total elbow joint replacement arthroplasty for arthritis is
an elective procedure that can be scheduled when circumstances are
optimal, the patient should have plenty of time to become informed and
to select and experienced surgeon.
Risks
The risks of total elbow replacement surgery include but are not limited to the following:
- infection
- injury to nerves and blood vessels
- fracture
- stiffness or instability of the joint
- loosening or wear of the artificial parts
- failure of the triceps tendon
- pain
- the need for additional surgeries
There are also risks associated with anesthesia and blood
transfusion (although transfusions are not always necessary). An
experienced elbow joint replacement team will use special techniques to
minimize these risks, but cannot totally eliminate them.
Managing risk
Many of the risks of total elbow joint replacement arthroplasty
surgery can be effectively managed if they are promptly identified and
treated. Infections may require a wash out in the
operating room; occasionally, removal of the artificial components is
necessary. Blood vessel or nerve injury may require repair. Fracture
may require surgical fixation. Stiffness or instability may require
exercises or additional surgery. Loosening or wear of the components
may require surgical revision.
If the patient has questions or concerns about the course after surgery, the surgeon should be informed as soon as possible.
Surgery for Elbow arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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