Have you been suffering from unbearable pain in your elbow for a long time? Your doctor may have talked to you about elbow replacement surgery. It's normal to feel a little scared and curious when you hear about this type of surgery. What exactly is this surgery? Let's talk about it simply, in a way that everyone can understand.
What does this mean, replacing the elbow joint?
Simply put, elbow joint replacement surgery involves removing your elbow joint and replacing it with an artificial joint. This is called joint replacement or arthroplasty in medical terms.
Think of it this way: our elbow joint is like a hinge on a door. Over time, this hinge can wear out, rust, and stop working properly. Our joints are like that too. Whether due to conditions like arthritis or a serious accident, when the cartilage in the joint wears away and the bones start to rub against each other, it can cause severe pain and stiffness.
This is when a surgeon removes the worn-out, damaged parts of your natural joint and replaces them with an artificial joint (prosthesis) made of metal and plastic. After this, you will be able to bend and extend your arm easily without pain.
What are the main types of this surgery?
There are several main types of elbow replacement surgery. Your doctor will decide which type is best for you. Let's understand these types clearly.
| Type of surgery | Simple description |
|---|---|
| Total Elbow Replacement | This is the most common type. Here, the damaged parts of the upper arm bone (humerus) and forearm bones (ulna and radius) are completely removed and an artificial joint is inserted. |
| Partial Elbow Replacement | This is exactly what the name suggests. Only the damaged part of the joint is replaced. This is not very common. It is usually done when only one part of the joint is damaged, such as in a serious accident. |
| Methods of implanting artificial joints | |
| Linked replacement | In this method, the artificial joint is like a hinge that is connected together. Its two parts are attached to the upper arm bone and the forearm bone with metal rods. This is the most stable and most commonly used method . |
| Unlinked replacement | Here, the parts of the artificial joint are not connected to each other. Instead, they are connected to naturally occurring ligaments and tissues. But to do this, those ligaments and tissues need to be very strong. By the time a joint is old enough to need replacement, the ligaments are usually too weak, so this method is rarely used. |
Who should undergo this surgery?
A doctor may recommend this surgery for people with severe symptoms who have not responded to other treatments (such as painkillers and physical therapy). The main symptoms are:
- Unbearable joint pain .
- Stiffness in the elbow.
- Inability to bend or straighten the elbow properly (limited mobility).
- Joint swelling .
The main cause of these symptoms is arthritis.
- Osteoarthritis: A condition caused by wear and tear of the joints as we age.
- Rheumatoid Arthritis: A disease caused by the body's own immune system attacking the joints.
- Post-traumatic arthritis: Arthritis that occurs years after a previous elbow fracture or dislocation.
In addition, this surgery may also be required in some severe elbow fractures.
How do you prepare before surgery?
Your doctor and surgeon will explain to you what you need to do before surgery. These are the things you will usually need to do:
- Physical examination: To see if you are healthy enough for surgery.
- Blood tests.
- ECG test: Check the functioning of the heart.
- Dental check-up: This may seem a bit surprising, but it is very important. Dental infections can travel through the bloodstream and infect the newly implanted joint. This is done to reduce that risk.
- Imaging tests: An X-ray of the elbow will definitely be taken. You may also be asked to do an MRI or CT scan.
Be sure to tell your doctor about any medications, vitamins, and supplements you are taking. You may need to stop taking some medications before surgery.
Important tip: Since you won't be able to use your elbow for a few weeks after surgery, it's a good idea to keep some of the items you need most at home (e.g. cups, combs, books) within easy reach of your other hand.
You will be advised on the time to stop eating and drinking the day before surgery. Usually, you will need to stop eating and drinking 12 hours before surgery.
The surgery and what happens afterwards
On the day of surgery, an anesthesiologist will numb your arm so you don't feel any pain. In addition, you will be given general anesthesia to help you sleep comfortably during the surgery.
By the surgeon:
1. An incision is made on the back of the elbow.
2. Damaged cartilage and bone fragments are removed.
3. The ends of the bones are adjusted to fit the artificial joint.
4. The prosthesis is implanted.
This surgery usually takes about two hours. After the surgery, you will be taken to a recovery room where the medical team will monitor your condition. You will usually have to stay in the hospital for a day or two.
Possible complications and what to be especially careful about
As with any surgery, there is a small risk of complications.
- Fracture of the bone around the graft.
- Infections at the surgical site or within the joint.
- Damage to nerves or blood vessels.
- Premature wear or loosening of the artificial joint.
- Limited movement of the hand due to scar tissue formation.
If you have other medical conditions like diabetes or osteoporosis, be sure to talk to your doctor about it.
The most important thing: weight lifting restrictions!
This is the most important thing to know about this surgery.
Unlike other joint replacements (knee, hip), the prosthetic parts placed in the elbow joint can be a little more delicate. This is because the bones in our hands are smaller and thinner than the bones in places like the hip or knee.
For this reason, many people who have this surgery are given a lifetime weight-bearing restriction on the operated arm . Typically, they are not allowed to lift more than 2.5 kilograms (5 pounds) with that arm. It is extremely important to follow this restriction exactly. Failure to do so can cause the prosthesis to loosen or break.
Recovery time and when to call the doctor
It can usually take about a year to fully recover. You may need to wear a splint or brace to keep your hand immobile for the first few weeks. After about 12 weeks, you should begin exercises under the supervision of a physical therapist. These exercises will help strengthen the muscles in your hand and restore movement.
It is normal to have some pain in the first few weeks after surgery. Use the painkillers your doctor prescribes exactly.
Seek medical advice immediately!
If you experience any of the following symptoms, go to your doctor or the nearest hospital Emergency Department (ETU) immediately.
| Symptoms to watch out for |
|---|
| • Chest pain |
| • Difficulty breathing (dyspnea) |
| • Fever over 101°F (39°C) |
| • Excessive bleeding from the surgical wound |
| • Signs of an infection: pus-like fluid draining from the wound, excessive swelling, discoloration, odor, or a warm feeling around the wound. |
| • Severe pain that is not controlled, even with painkillers. |
Although it's a big change to not be able to lift weights with one arm for the rest of your life, this surgery is well worth it to get rid of the constant pain and improve your quality of life. So, talk to your doctor about this carefully and make the decision that's right for you.
Take-Home Message
- Elbow joint replacement surgery is performed as a solution to severe pain and stiffness that has not been relieved by other treatments.
- It takes about a year to fully recover, and physical therapy exercises are mandatory.
- The most important rule: Avoid lifting heavy objects (usually more than 2.5 kg) with the operated hand for the rest of your life.
- Before surgery, carefully discuss the benefits and risks with your doctor.
- If you notice warning signs such as high fever, unbearable pain, or signs of wound infection, seek medical advice immediately.
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