Introduction
An elbow replacement procedure is generally conducted for a patient where there has been substantial degeneration in the elbow joint resulting in severe ongoing pain. Elbow replacement surgery is generally not recommended for patients who are involved in high demand physical activities, as any increased wear and tear on the prosthetic joint heightens the risk of the artificial joint loosening. For this reason, patients undergoing an elbow replacement are advised to avoid doing any lifting with the affected arm after this surgery.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g. water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts / tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
An elbow replacement procedure is carried out under a general anaesthetic and takes around 2 hours.
It involves firstly making a long incision to the outside of the elbow and then releasing and protecting the ulnar nerve, which is very close to the area needing to be operated on.
Then a thin sliver of bone is removed from the olecranon process (the widened outer upper part of the ulna bone in the forearm), while at the same time the tendon of triceps muscle is detached to give access to the elbow joint.
The surfaces of the joint are then prepared, small sections of bone are removed ('resected') and the elbow replacement components (generally made of metal and lined with polyethylene to allow smooth movement of the joint) are fitted into place. Once this is completed the triceps tendon is reattached, the ulnar nerve is repositioned and the incision is closed.
Postoperative Instructions
Patients undergoing an elbow replacement procedure generally need to stay in hospital for 3-4 days. For the 14-day period after surgery it is important to protect the elbow to allow the triceps tendon to heal and you may have the arm put in a splint for this reason. It is not uncommon for there to be some swelling around the nerves in the elbow which may cause temporary changes to sensation in the hand. Full recovery from elbow replacement surgery can take up to 6 weeks, during which time it is advisable not to lift anything heavier than a glass of water with the affected arm.
Risks
As with any surgery, with elbow replacement surgery there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
- Damage to nerves / blood vessels.
Specific risks of elbow replacement surgery include:
- Allergic reaction to the prosthetic joint components.
- Bone fracture.
- Restriction in range of movement.
- Instability / stiffness in the joint.
- Wear and tear and / or loosening of the components.
- Weakness or failure of tendons in the arm.