Quick Guide to Elbows

This page provides a brief introduction to elbow replacement. It can help you make a list of questions to ask your doctor, but it is not meant to provide complete information. Check with your surgeon's office about more comprehensive resources and patient education materials.

How do I prepare for elbow replacement surgery?
If you and your surgeon decide that total elbow replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff member, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.

What happens during elbow replacement surgery?
On the day of surgery, an intravenous tube will be inserted into your unaffected arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your elbow will be scrubbed and sterilized with special solution.

The procedure is performed through an incision over the elbow that will expose the joint. Special, precision guides and instruments will be used to cut the ends of the humerus (upper arm bone) and ulna (forearm bone), and prepare the bone to accept the implant. The implants are then inserted and fixated in place with a special kind of opoxy cement for bones. The two parts of the hinge are then brought together and secured with a pin. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. The surgery usually takes one to three hours, although this depends on the severity of the arthritis in your elbow.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. Your arm will be in a splint, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?
When you are back in your hospital room, you will begin a gentle rehabilitation program to help relax the muscles around your new elbow. On the day of surgery you may be encouraged to get out of bed and take a few steps. You will continue to receive pain medication as needed, and your bandage will be removed about two days after surgery.

Depending on your specific situation, you will probably remain in the hospital from one to three days. Your elbow area may be warm and tender for several weeks. Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recovery.

How soon can I return to normal activities after surgery?
Successful joint replacement surgery may relieve your pain and stiffness, and allow you to resume some of your normal daily activities as instructed by your doctor. While you are recovering, you should not lift more than one pound with the operated arm. Even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities for elbow replacement patients do not include contact sports, "jamming" activities such as hammering, heavy or repetitive lifting, or activities that put excessive strain on your elbow. Your doctor may advise you not to lift anything that weights more than five pounds. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.

How long will an elbow replacement last?
Longevity of the prosthetic elbow varies from patient to patient. It depends on many factors, such as a patient's physical condition and activity level, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient's life.

Today, total elbow replacement is becoming a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic elbow can do and how much activity it can withstand. As with any mechanical joint, the components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the elbow joint is used. Activities that place a lot of stress on the joint implants, as may be the case with more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the components can lead to the necessity for revision surgery to replace the worn parts, or all of the parts. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Talk with your doctor about the following points, and how they might affect the longevity and success of your elbow replacement:

• Avoiding repetitive lifting; avoiding lifting anything heavier than one pound during recovery; and avoiding lifting anything heavier than five pounds after recovery.

• Avoiding "jamming" activities such as hammering

• Staying healthy and active

• Avoiding "impact loading" sports such as boxing

• Consulting your surgeon before beginning any new sport or activity, to find out what type and intensity of sport or activity is appropriate for you

• Thinking before you move

• Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses on the operated elbow

• Not pushing heavy objects