Elbow replacement surgery (also called elbow arthroplasty) is done to treat problems caused by arthritis in the elbow. It has become the most common procedure used by older adults to replace joints damaged by fractures.
More than 90% of patients who underwent elbow joint replacement in Turkey considered the prosthetic facility to be successful.
The elbow joint is made up of three bones: the upper arm bone (the humerus), the lower arm bone on the side of the thumb (the radius), and the lower arm bone on the pinky side (the ulna).
The humerus and ulna meet to form a joint that allows your arm to flex.
The way the humerus and radius connect to the lower arm allows it to rotate between the up and down positions of the palm of the hand.
An elbow replacement is considered a major surgery that carries significant risks and potential complications.
What makes elbow joint replacement surgery Elbow replacement necessary?
Joint replacement surgery is usually considered the last resort to treat a severely damaged elbow joint after all other avenues have been exhausted. An artificial joint replaces damaged surfaces with metal and plastic designed to fit together and rub against each other smoothly.
This, in turn, eliminates the pain of rubbing the bones together.
The most common reason for artificial elbow replacement is arthritis.
There are two main types of arthritis, degenerative and rheumatic.
Degenerative arthritis is also called wear-and-tear arthritis or osteoarthritis.
Any injury to the elbow can damage the joint and lead to osteoarthritis.
But arthritis may not appear for many years after an injury.
There are many types of systemic arthritis as well.
The most common form is rheumatoid arthritis. All types of systemic arthritis are diseases that affect many or even all of the body's joints.
Systemic arthritis destroys the cartilage lining of the joints.
An immediate elbow replacement may also be done after certain types of elbow fractures, usually in older adults.
Because elbow fractures are difficult to surgically repair in many older people, the bone may also be weakened by osteoporosis.
(People with osteoporosis have bones that are less dense than they should.) Weak bones make it very difficult for the surgeon to use metal plates and screws to hold the broken parts in place long enough for them to heal together.
In such cases, it is sometimes best to remove the broken parts and replace the elbow with an artificial joint.
What do I need to know before surgery?
You and your surgeon must make a decision about whether to proceed with surgery together.
You need to understand as much as possible about the elbow joint replacement process in Turkey.
If you have concerns or questions, you should speak to your surgeon.
Once you've decided on surgery, you need to take several steps. Your surgeon may suggest a complete physical exam by your regular doctor. This test helps make sure that you are in the best possible condition for the procedure.
You may also need to spend time with a physical or physical therapist who will administer your rehabilitation after surgery.
This allows you to recover faster.
One of the purposes of this pre-operative visit is to record well the progress of the case. Your therapist will check your current pain levels, ability to do your activities, and the movement and strength of each elbow you have.
The second purpose of visiting a physical therapist before surgery is to prepare you for surgery.
This is where you will begin to learn some of the exercises that you will use during your recovery period.
A therapist can help you anticipate any special needs or problems you may have at home, once you are discharged from the hospital.
On the day of your surgery, you'll likely be admitted to the hospital early in the morning.
So you should not eat or drink anything after midnight the night before the operation.
Be prepared to stay in the hospital for at least one night.
Elbow joint replacement surgery
What happens during elbow joint replacement surgery?
Replacement surgery is usually not used until it becomes impossible to control symptoms without surgery.
If replacement becomes necessary, it can be a very effective way to relieve arthritis pain and restore normal elbow use.
Before we describe the procedure, let's first look at the artificial elbow itself.
There is more than one type of artificial elbow joint (also called a prosthetic joint). The most common type is the hinge joint.
Each prosthesis consists of two parts.
The humeral component replaces the lower end of the humerus in the upper arm.
The humeral part of the artificial joint has a long stem that fixes it in the hollow center of the humerus.
The ulnar part replaces the upper end of the ulna in the lower arm.
The ulnar part also has a shorter metal stem that attaches it to the hollow center of the ulna.
The hinge between the two components is made of metal and plastic. The plastic part of the hinge is hard and smooth. It allows two pieces of the new joint to easily slide against each other while moving your elbow.
The hinge allows the elbow to flex and straighten smoothly.
There are two different ways to hold the prosthetic elbow in place.
An adhesive prosthesis uses a special type of epoxy cement to attach to the bone.
The uncut prosthesis has a fine network of holes on the surface.
Over time, the bone grows into the mesh, attaching the prosthesis to the bone.
Before elbow joint replacement surgery
What should I do to prepare for elbow replacement surgery?
Your doctor may ask you to stop taking certain medications before elbow replacement surgery. These medications can cause additional bleeding and include:
- Arthritis medications.
- blood thinners;
- Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and aspirin.
You will have limited arm movement for several weeks after elbow replacement surgery while you recover.
Before surgery, you may want to move items you use regularly to lower shelves in your home so they are easily accessible.
Most elbow replacement surgeries are done under general anesthesia (general anesthesia that puts you to sleep).
In some cases, the surgery is performed under local anesthesia, which numbs only the nerves in the arm.
If you use local anesthesia, you may also be given medications to help you sleep shallowly, so that you are not familiar with the surgery.
After anesthesia, the surgeon makes an incision in the back of the elbow joint. The incision is made on the back side because most of the blood vessels and nerves are inside the elbow
. Rear entry also helps prevent damage.
Then the tendons and ligaments are moved away from the elbow.
Also, care must be taken to move the ulnar nerve that runs along the elbow to the hand.
Once the joint is exposed, the first step is to remove the joint surfaces from the ulna and radius.
This is usually done with a surgical saw. Then the surgeon uses a special device to empty the marrow space within the ulna bone to stabilize the metal stem of the ulnar component.
The ulnar component is then inserted into the bone to test for fit.
When the ulnar portion is properly fitted, the surgeon repeats the procedure on the humerus.
After the humeral segment is fitted, the surgeon puts the implant parts together and checks to see if the hinge is working properly.
Then the implant is removed, and the bone is prepared to hold it in place.
The pieces are then snapped into place and assembled together. After double-checking for proper fit and movement, the surgeon stitches up the incision.
Your elbow will likely be placed in a bulky bandage and splint. You will then be woken up and taken to the recovery room.
Complications of elbow replacement surgery
Does elbow replacement surgery cause any complications?
As with all major surgeries, complications can occur. Some of the more common complications after an elbow replacement are:
- Injury to nerves or blood vessels
Problems can arise when the anesthesia given during surgery causes a reaction against other medications the patient is taking.
In rare cases, the patient may have problems with the anesthesia itself.
Additionally, anesthesia can affect lung function because the lungs do not expand well when a person is under anesthesia.
So be sure to discuss the risks and your concerns with your anesthesiologist.
Infection after elbow joint replacement surgery
Infection after joint replacement surgery can be very serious.
The chances of developing an infection after most prosthetic joint replacements are low, about one or two percent.
An elbow replacement has a somewhat higher chance of infection, for many reasons. It is because the skin is thin around the elbow, and there are no muscles covering the joint. This makes wound complications more common.
Elbow replacements are also often performed for people with rheumatoid arthritis. Immunosuppressants and medications used to treat rheumatism affect the body's immune system, making it difficult to fight infection.
Sometimes the infection appears very early, before you leave the hospital.
The infection may not appear at other times for months or even years after the operation.
The infection can also spread to the artificial joint from other affected areas.
Once the infection has settled in your joint, it is nearly impossible for your immune system to get rid of it.
You may need to take antibiotics when you have surgery at the dentist or surgery on your bladder and colon.
Because antibiotics reduce the risk of germs spreading to the artificial joint.
The main reason artificial joints eventually fail is that they loosen as metal or cement rubs against bone.
A loose joint implant can cause pain.
If the pain becomes unbearable, another operation is likely to be needed to repair the artificial joint.
Significant progress has been made in extending the life of artificial joints.
However, most implants will eventually disintegrate and require further surgery.
Younger, more active patients are at greater risk of flaccidity. A knee prosthesis can last about 12 to 15 years, but elbow prostheses tend to loosen sooner.
Nerve or blood vessel injury
All nerves and large blood vessels travel to the forearm and hand through the elbow joint.
Because the surgery is done near these nerves and blood vessels, they can be injured during surgery.
This injury may be temporary if the nerves are tightened by spacers that hold them out of the way during the procedure.
Although permanent injury to nerves or blood vessels is uncommon, it is possible.
After elbow joint replacement surgery
What can I expect immediately after surgery?
After surgery, your elbow will likely be covered with a large bandage and a splint.
Depending on the type of implant used, your elbow will be positioned straight or slightly bent.
You may also have a small plastic tube that drains blood from the joint. Because the drainage prevents excessive swelling of the blood. (This swelling is sometimes called a hematoma.)
The drain tube will likely be removed the first day. Then assisted elbow movements are started by a physical or occupational therapist the day after surgery.
The surgeon will want to examine your elbow within five to seven days. The stitches will be removed after 10 to 14 days, although most of the stitches will be absorbed into your body.
You may feel some discomfort after the surgery. So you will be given pain medication to control your discomfort.
You should keep your elbow elevated above the level of your heart for several days after elbow replacement surgery to avoid swelling and throbbing. Keep it elevated on a pile of pillows when sleeping or sitting.
Rehabilitation after elbow joint replacement surgery
When will I be able to use my elbow again?
will physical therapist Or a professional directing your rehabilitation program.
Recovery takes up to three months after elbow replacement surgery. The first few treatments will focus on controlling pain and swelling from surgery.
Heat treatments may be used. Your therapist may also use gentle massage and other types of practical therapies to relieve muscle spasms and aches.
Then you will begin gentle range-of-motion exercises. Strengthening exercises are used to give more stability around the elbow joint. You will learn ways to lift and carry objects in order to perform your tasks safely and with minimal stress on the elbow joint. As with any surgery, you should avoid doing too much work too quickly.
Some of the exercises you will do are designed to make your elbow work in ways similar to your daily work tasks and activities. Your therapist will help you find ways to do your job that don't put too much stress on your new elbow joint. Before your therapy sessions are over, your therapist will teach you a number of ways to avoid future problems.
Your therapist's goal is to help you manage pain, improve your strength and range of motion, and maximize the use of your elbow.
When will I recover after elbow joint replacement surgery?
You should be able to go home after two to five days.
You will need to use an elbow brace for 6 weeks.
Regular exercise should help you get back to normal activities as soon as possible.
Before you start exercising, seek advice from your health care team or your GP.
Most people recover well, have less pain, and can move their elbow better.
But whatever it is, an artificial elbow does not resemble a natural elbow. An elbow replacement can wear out over time.
What should I expect after elbow joint replacement surgery?
Most people need to keep their arm raised as much as possible for several days after elbow replacement surgery to reduce swelling.
Your doctor will give you medications, including NSAIDs, to control the pain.
You'll learn gentle exercises to help the elbow heal and improve your ability to move it.
In most cases, doctors ask people to wait up to six weeks after surgery to apply forceful hand pressure or bear weight on the affected arm.
Many patients work with physical therapists in a supervised rehabilitation program.
When should I contact my doctor?
After elbow replacement surgery, call your doctor if you have:
- Bleeding, redness, warmth or bleeding at the incision site.
- Feeling of dislocation or looseness of the new joint.
- A fever over 101 degrees Fahrenheit with no other symptoms.