Elbow Replacement

Total elbow arthroplasty replaces a severely damaged elbow joint. It is done for osteoarthritis and rheumatoid arthritis, for severe fractures around the elbow, for stiffness and degeneration, after earlier elbow surgery has failed, for extensive tissue damage, and for tumours in or beside the joint. Partial replacement — replacing only the radial head — is an option where the damage is confined there.

Two kinds of implant

A linked prosthesis works like a hinge, with all parts joined; it is stable but can loosen over time. An unlinked prosthesis has two separate components and relies on your own ligaments for stability, so it is more prone to dislocation. Both are made from titanium and medical plastics. Which one is right depends on how much good bone and ligament you still have.

The operation

Around two to three hours. The surgeon works through an incision at the back of the elbow, moves the muscles aside, clears scar tissue, prepares the humerus and the ulna, and fixes the stems into both bones with bone cement. A small drain is left in and removed within days. Before surgery you will have an examination of movement and strength, X-rays, often MRI, CT or a bone scan, and blood tests.

Recovery, and the restriction that lasts

Hospital stay is one to four days. Physiotherapy starts soon after surgery with gentle bending; if you are in a splint it starts a few weeks later. Full function takes twelve weeks to a year. Driving usually returns at four to six weeks with medical clearance, and flying is generally advised after five to six months — you will need a certificate for metal detectors.

The restriction to understand before you consent is the lifting limit. Your surgeon will set a maximum weight, and it is permanent: exceeding it can damage the prosthesis or dislocate its components. An elbow replacement lasts up to about ten years on average, and revision surgery is possible if it fails.

Before you agree to anything

Ask which prosthesis is proposed and why, what your lifting limit will be in kilograms, and whether your work or daily life can live within it. That last question is the one people wish they had asked.