Total elbow joint replacement for elbow arthritis: Surgery with a dependable, time-tested prosthesis can lessen pain and improve function in elbows, especially those with rheumatoid arthritis.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Tuesday, November 13, 2007
Recovering from surgeryPain and pain management Recovery of comfort and function after elbow arthroplasty continues for many months after the surgery.
Elbow replacement arthroplasty is a major surgical procedure that
involves cutting of skin, tendons and bone. The pain from this surgery
is managed by the anesthetic and by pain medications. Immediately after
surgery, strong medications (such as morphine or Demerol) are often
given by injection. Within a day or so, oral pain medications (such as
hydrocodone or Tylenol with codeine) are usually sufficient.
Pain medications can be very powerful and effective. Their proper
use lies in the balancing of their pain relieving effect and their
other, less desirable effects. Good pain control is an important part
of the postoperative management.
Use of medications Initially, pain medication is usually administered intravenously or
intramuscularly. Sometimes patient controlled analgesia (PCA) is used
to allow the patient to administer the medication as needed.
Hydrocodone or Tylenol with codeine are taken by mouth. Intravenous
pain medications are usually needed only for the first day or two after
the procedure. Oral pain medications are usually needed only for the
first two weeks after the procedure.Important side effects Pain medications can cause drowsiness, slowness of breathing,
difficulties in emptying the bladder and bowel, nausea, vomiting and
allergic reactions. Patients who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some patients, balancing the
benefits and side effects of pain medication is challenging. Patients
should notify their surgeon if they have had previous difficulties with
pain medication or pain control. Elbow replacement arthroplasty is a
major surgical procedure that involves cutting of skin, tendons and
bone. The pain from this surgery is managed by the anesthetic and by
pain medications. Immediately after surgery, strong medications (such
as morphine or Demerol) are often given by injection. Within a day or
so, oral pain medications (such as hydrocodone or Tylenol with codeine)
are usually sufficient.Hospital stay After surgery the patient spends an hour or so in the recovery room.
A drainage tube is usually used to remove excess fluid from the
surgical area. The drain is usually removed on the second day after
surgery. Bandages cover the incision. They are usually changed the
second day after surgery.
Elbow motion soon after total elbow replacement helps achieve best
possible elbow function. During the hospitalization, the patient learns
a simple rehabilitation program that will be used for maintaining the
range of motion at home after discharge. On the second day after
surgery, the physical therapist teaches the patient gentle range of
motion exercises. These include flexion (bending), extension
(straightening), pronation (palm down) and supination (palm up).
Hospital discharge Patients are discharged as soon as:
- the incision is dry,
- the elbow is comfortable with oral pain medications,
- the patient can perform the range of motion exercises, and
- the home support systems for the patient are in place.
Discharge is usually on the third or fourth day after surgery. Convalescent assistance Walking and use of the arm for gentle activities are encouraged soon after surgery.
For the first month or so after this procedure, the operated arm may be less useful than it was immediately beforehand.
The patient's specific limitations can be specified only by the
surgeon who performed the procedure. It is important that the repaired
elbow not be challenged until it has had a chance to heal. Usually the
patient is asked to lift nothing heavier than a cup of coffee for six
weeks after the surgery.
Management of these limitations requires advance planning to
accomplish the activities of daily living during the period of
recovery.
Patients usually require some assistance with self-care, activities
of daily living, shopping and driving for approximately six or so weeks
after surgery. Patients usually go home after this surgery, especially
if there are people at home who can provide the necessary assistance,
or if help can be arranged through an agency. In the absence of home
support, a convalescent facility may provide a safe environment for
recovery.
Recovery of comfort and function after elbow arthroplasty continues
for many months after the surgery. Improvement in some activities may
be evident as early as twelve weeks. With persistent effort, patients
make progress for as long as a year after surgery. Surgery for Elbow arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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