Elbow Replacement Surgery

What is a Elbow Replacement Surgery?

Elbow Joint Replacement, also known as Total Elbow Arthroplasty is a procedure designed to treat advanced arthritis of the elbow joint.

The elbow is a hinge joint formed by three bones the upper arm (Humerus) with the lower arm bones (Radius & Ulna) and when the function of this joint is impaired by arthritis, the elbow joint can become painful and less mobile.

The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint.

When is Elbow Replacement Indicated

Elbow joint replacement surgery may be recommended for the treatment of severe arthritis that has not responded to conservative treatment options such as medications or steroid injections.

Other indications for elbow joint replacement surgery may include:

Severe elbow fracture in older patients with osteoporosis; a disease that causes bone loss and raises the risk of fractures
Tumour or growth in the elbow joint
History of previous elbow surgery
Overall good health

Elbow Replacement Procedure Steps

The procedure is performed after appropriate diagnostic assessments, pre surgery checks and preparations are complete in a hospital and normally takes less than 90 minutes.

The procedure is performed under a general anaesthetic and includes the following steps:

Small incision is made over the back of the elbow.
Muscles are retracted, and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.
Damaged surfaces of the humerus, radius, and ulna are trimmed to create a smooth surface for the attachment of the implants.
Inside humerus bone is hollowed and the prosthesis implant is insert and fitted
Inside ulna bone is hollowed tand the prosthesis implant is insert and fitted
Bones are then prepared and components are then inserted and combined ensuring proper movement of the hinge portion of the prosthesis.
Joint components are tested through its range of motion.
Joint capsule is then sutured together, the muscles and tendons are repaired and the skin sutures
The elbow is then dressed and bandaged.

Elbow Replacement Surgery Preparation

Once you and the doctor have decided that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery.

Infections - Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Smoking - Stop or cut down smoking to reduce your surgery risks and improve your recovery
Weight - Consider losing weight (if overweight) before surgery
Medications - Refrain from taking medications or dietary supplements that may increase your risk of bleeding - refer Medication Information
Fasting - Depending on the type of anaesthesia used, your doctor may advise you to refrain from eating and drinking six to twelve hours before the procedure.
Getting Home - You will not be allowed to drive yourself home after the procedure, so make arrangements for someone to pick you up. If you live alone, arrange for someone to check on you that evening or, ideally, to stay with you for the rest of the day.
Loose Clothing - If you're having surgery, wear loose, comfortable clothing, such as baggy gym shorts and slip-on shoes, so you can easily undress and dress.

Things to Avoid
- Stop or cut down on smoking to reduce your surgery risks and improve your recovery
- Avoid chemical peels and needling
Pre Surgery Tests
- Pain medications are prescribed to help with pain during the recovery phase.
- After your operation, you will have a drip in your arm for pain medication and antibiotics.
- You may need between 1 - 3 nights in hospital.
- Crutches are required for 1 – 2 weeks following the replacement. Once you are off crutches, you can begin driving.
- If any postoperative problems arise with your knee, such as redness, increasing pain or fevers, do not hesitate to contact Dr Edward Graham. If unavailable, seek advice from the hospital or your doctor.
- Going home remember to arrange for someone to take you home, no driving is recommended.

Medication Information
Regardless of whether you are expecting to have treatment or just a consultation please advise the doctor of any medications you are taking, including:
- Aspirin, Anti-inflammatory or Blood-thinning medications,
Discuss which ones should be stopped before surgery like aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding 7 days before surgery to minimise bleeding
- Review blood replacement options (including banking blood) with your doctor
Physical & Mental Prep
Physical Preparation
- Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
- consider losing weight (if overweight) before surgery to help decrease the stress on the new joint.
- Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Mental Preparation
Preparing mentally and physically for surgery is an important step toward a successful result.

Your doctor will create a treatment plan and patients will also need to understand the process and their role in it

Returning Home After Surgery

When you go home you need to take special precautions around the house to make sure it is safe. Your post operative plans should include:

Mobility or Stability - changes (rails in your bathroom, ramps for stairs)
Sleeping - modify your sleeping arrangements (especially if you are sleeping upstairs) for easy access
Access - ensure you have easy access to food, water, medications and any other essentials
Showering - will be allowed once the wound is healed, or as indicated

Assess your home situation to ensure you have adequate home support in the first few weeks following surgery. If you live alone it may be necessary to arrange a package of community care to help during the first few weeks at home.

Elbow Replacement Surgery Process

Day of Surgery
- Report any infections to me prior to surgery as the procedure cannot be performed until all infections have cleared up.
- Do not consume alcohol - 24 hours prior to treatment,
- Do not eat or drink anything, including water, for 6 hours before surgery
- Avoid vigorous physical activity or exercise 24 hours prior to surgery
Surgery Recovery
In the recovery ward
- You will awaken after surgery in the recovery ward
- You will be observed & monitored
- Advised of pain relief & what is next
- When appropriate you will be moved to the ward

During Surgery
- Administration of General Anaesthesia
- The entire procedure can take 60 minutes to two hours.
- The procedure is performed and sent to the recovery room, for observation
- Pain medications are prescribed to help with pain during the recovery phase.
Post Surgery Care
- You will probably stay in the hospital for 4-5 days after the surgery.
- Your pain will be managed with a PCA machine (patient-controlled analgesia), injections or pain pills. A PCA machine enables you to push a button to deliver a dose of pain medicine through an IV.
- Your arm will be in a sling or splint with a bulky dressing.
- You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 days.
- Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.
- Occupational therapy (OT) will begin soon after surgery and continue for about 3 months to regain full range of motion of the elbow joint.
- Sutures will usually be removed after 10-14 days.
- Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.
- You will be given specific instructions regarding activity and rehabilitation.
- Eating a healthy diet and not smoking will promote healing.

Elbow Replacement Rehabilitation Program

1 Week - Post Op Rehab
Your Rehab Program starts soon after your procedure, it involves
- Physical therapy to help you regain strength and control
- Setting recovery goals for pain relief, movement, strength
6 Weeks - Post Op Rehab
Your Rehab Program will have progressed
- Your weight-bearing is advanced to full weight
- 6 weeks post-op your brace is replaced with a lateral stabilizer brace.
- 8 weeks post-op your brace should no longer be required
32 Weeks - Post Op Rehab

Elbow Replacement Risks & Complications Associated

General Surgery Risk
General Complications With Surgery

All operations have risks. Apart from pain, most patients don’t have any of these problems. The general risk of a surgical complication is about 5%, the Risk of serious complications is less than 1%. General complications from surgery can include:
- Anesthetics - Allergic reactions to medications
- Bleeding & Blood Loss -Blood loss requiring transfusion with its low risk of disease transmission
- Blood Clotting - Blood clots can form in the leg’s calf muscles causing Deep Venous Thrombosis (DVT) and can travel to the lung (Pulmonary Embolism). These can occasionally be serious and even life-threatening (Heart Attack, Stroke). If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
- Infection - During or Postoperative Infection can occur with any operation. Infection rates are approximately 1%, if an infection occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
- Death Due to Surgery - Serious medical problems can lead to ongoing health concerns (kidney failure, pneumonia, bladder infections, causing prolonged hospitalization and in rare cases death.
- Delayed Healing - Some patients take longer to heal than others, particularly people with more than one illness
- Difficulty Breathing - Most patients can be removed from the breathing machine after their surgery. Some patients can require the ventilator longer or lung function rehab
- Surgical Injury - When having surgery there is the risk that parts of the body will be damaged in the process
- Other Complications - Tingling, Numbness or Discomfort Around the Operative Region, Swelling & Bruising, Muscle Stiffness, Reflex Sympathetic Dystrophy, Scarring

Surgical Follow Ups

6 Weeks After Surgery
At the 6 Week Check-Up your surgeon, who will assess your progress:
- Check-Up with Surgeon
- X Rays
At this time you should be able to:
- Bend the knee to 90 degrees,
- Use a cane and walk comfortably,
- Drive a car
32 Weeks After Surgery
- Check Up with Surgeon
- X Rays
Ongoing Care

You should continue to see your surgeon for the rest of your life to check your knee and take X-rays.

This is important as sometimes your knee can feel excellent, but there can be a problem only recognised on X-ray

How Risks Are Minimised

Get Moving Quickly

Early mobilisation is a major preventive measure. We strongly encourage you to get moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs.

You should aim to do at least ten short walks (of between 2 and 5 minutes) each day in the first two weeks after surgery.

How Can I Minimise Post Operative Complications

Blood clots (DVT or PE)

All patients receive a number of treatment measures to reduce the risk of blood clots. These include

Injections of heparin during and after surgery,
Sequential calf compression device (SCD) whilst on the operating table, and
Special leg stockings (TEDS)

As a result of these measures, we have never had a patient develop a deep venous thrombosis. Any patient who is at high risk of a blood clot (such as a history of blood clots or clotting disorders) may be asked to continue heparin (Clexane) injections for 10 days after the surgery in addition to the other measures. This can be done at home, and we will show you how.

What Are the Consequences of Surgery?

Sometimes the potential risks and consequences of your surgical procedure need to be weighed against the benefits of a successful surgical outcome.

Like most surgery these benefits can include:

Freedom from pain
Increase movement
Greater Flexibility,
Maintained Independence
Improved outlook, and
Longer more enjoyable life

Although the recurrence of the presenting problem is not very common, after surgery, you would need to follow preventive measures.

It is important to avoid high impact activities during the early phase of recovery to minimise the risk of further injury. If there are any postoperative concerns or pain, please do not hesitate in contacting our rooms.