Total elbow replacement: who is it for and what can be expected

What is an elbow prosthesis?

An elbow prosthesis is an artificial implant designed to replace part or all of the elbow joint. In general, we can classify them according to the part of the joint they replace:

• Partial prosthesis: only the end of a bone is replaced. The most commonly used is the radial head prosthesis, which replaces the part of the radius that forms the elbow joint. Other partial prostheses are the distal humerus prostheses, which replace only the end of the humerus.
• Total prosthesis: the parts of the humerus and ulna that form the elbow are replaced and, in some designs, the radial head is also replaced. This article will focus on this type of prosthesis.

How is the need for a total elbow prosthesis diagnosed?

People suffering from severe elbow problems have difficulties that significantly affect their daily life, as they cannot stabilize, orient and position the hand far or close to their body and, on many occasions, suffer very intense and disabling pain. This implies not being able to do everyday things such as bringing the hands to the face, eating, getting dressed or reaching the objects we need.

These functions are performed by the elbow joint and, moreover, cannot be compensated by any other joint, so when they are limited, they cause great disability. For this reason, elbow prostheses are a second chance for those patients with serious diseases such as fractures, arthritis or osteoarthritis in which a part, or all of the elbow, ends up destroyed, losing mobility and appearing persistent pain and resistant to medication.

The need to resort to an elbow prosthesis is determined by two factors:

1. The appearance of pain and, sometimes, lack of mobility that do not improve with conservative treatment (medicines, physiotherapy, infiltrations, etc.).
2. That the symptoms are due to a non-recoverable destruction of the joint, there being no alternative but to replace it. This situation can be reached by different types of diseases. There are acute problems, such as complex fractures in which bones and/or ligaments are severely damaged to the point that they cannot be repaired, and a prosthesis must be implanted to replace the fractured bone ends. However, on other occasions, the elbow is progressively destroyed to the point of becoming useless, as in the case of inflammatory arthritis or post-traumatic osteoarthritis.

The main diseases in which elbow prostheses are used as treatment are:

• Severe fractures of the distal humerus.
• Chronic osteoarthritis caused by fractures and trauma.
• Inflammatory arthritis, such as rheumatoid arthritis.
• Absence of healing (pseudoarthrosis) of fractures of the distal part of the humerus.
• Severe elbow stiffness due to different causes.
• Massive bone loss due to tumors or trauma.

How is the surgical technique of the total elbow prosthesis?

To implant an elbow prosthesis, an incision is made in the posterior region of the elbow, advancing between the muscles and tendons until reaching the diseased ends of the bones that form the elbow joint. These diseased bone ends are replaced with technologically advanced mechanical components, which are held inside the bones of the arm and forearm with surgical cement. Afterwards, the components of the prosthesis are attached to stabilize and join the arm to the forearm (like a hinge), the elbow is checked to ensure that it can move and that it is stable, and the wounds are closed.

How is the recovery from total elbow replacement surgery?

The elbow prosthesis is ready to function from the moment it is implanted, so the recovery period is focused on taking care of the soft tissues surrounding the prosthesis that have been damaged by both the joint disease and the surgery.

Your surgeon may choose to immobilize the elbow with a splint for a few days or may instruct you to start moving the elbow the day after surgery, depending on the condition of the soft tissues.

A bandage is usually used for the first few days to contain swelling and bruising. The material used to suture the wound (staples or stitches) is removed between the second and third week. Shoulder, wrist and finger mobilization exercises are started immediately.

Mobilization of the elbow is performed as soon as possible, with assistance from the other hand. The need for formal rehabilitation with the help of specialized physiotherapists, and the moment to begin will be established by your surgeon according to your evolution. There are some recovery times to take into account, but they are variable from person to person and their variation does not necessarily imply the existence of a problem.

• At 3 weeks the swelling goes down significantly.
• At 6 weeks the patient notices how it is becoming easier to use his elbow on a daily basis.
• Between the sixth week and the third-fifth month, the speed of recovery and normal day-to-day use is reached.
• Subsequently, the elbow and symptoms may gradually improve even in some people until they reach one year.

What results are achieved with total elbow replacement surgery?

Elbow replacements have been shown to decrease pain, increase mobility, and improve function in most patients.

There are, however, some differences in the success rates of the procedure, depending on the disease being treated and how the patient cares for his or her joint. However, in general, in expert hands, 80% of patients can be expected to have good or excellent results.

How long the implant lasts depends on multiple factors, such as:

• The underlying disease.
• The patient’s use of the elbow.
• The prosthesis model.
• The quality of the surgery performed.

The elbow prosthesis is used in people with very severe and rare elbow problems, so there are few professionals familiar with this surgery. For this reason, it is very important to choose your surgeon very well. The surgeon must have as much experience as possible with this type of surgery in order to maximize the chances of improving pain, movement and function, while minimizing the risk of complications. These complications include injury to the nerves that give life to the hand (especially the ulnar nerve), infections, wear and tear of the prosthesis, or even fracture of the bones containing the implant.