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Total elbow replacement​

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The elbow joint consists of three main bones – the bottom of the humerus, the top of the radius and ulnar. In surgery to replace the total elbow joint, damaged parts of the humerus and ulna are replaced with artificial components.

 

A total elbow joint replacement generally occurs when a patient suffers severe elbow arthritis which does not respond to conservative treatment. Arthritis is a broad term with different types but generally it refers to conditions where the joint spaces narrow and the joint surfaces “wear out”. In arthritis, the cartilage which covers the bone ends and helps smooth the movement of a joint, wears out leaving the bones rubbing on one another. This causes pain, swelling, stiffness and reduced movement.

 

During the procedure, an incision is made at the back of the elbow and the damaged joint surfaces of the humerus and ulnar are removed and replaced with an artificial hinge joint.

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total elbow replacement and prosthesis

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

 

Following surgery, the incision will have sutures holding it closed and it will be covered with a water-resistant dressing. Post-operatively, a back-slab will be applied to immobilise the elbow for the first two weeks. Keep all of the bandages and dressings intact and dry until the first post-operative appointment.

 

A plastic bag tied above the elbow can be used to prevent the arm from getting wet during showering, or alternatively a one-handed bath can be taken.

 

The artificial joint replacement must be protected in order for it to correctly integrate with the bones. There must be no weight bearing through the arm for the first six weeks. Following this initial period, weight bearing is limited to no more than 5kg through the affected arm for the long term.

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10-14 days after surgery

  • Post-operative back-slab will be removed, and the wound dressed;

  • Tubigrip (or similar) will be applied to the elbow to reduce post-operative swelling;

  • Scar management will be commenced, if suitable;

  • Commencement of active and gentle/passive elbow flexion and extension with forearm in a neutral position in a seated, standing or supine position;

  • Active and gentle passive forearm rotation will commence in a seated or standing position with the elbow flexed to 90 degrees;

  • Strictly no weight bearing through the arm;

  • A sling will be provided for protection.

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Weeks 4-8 post surgery:

  • Continuation of active and passive range of motion exercises;

  • Use of sling can stop;

  • Light functional use of the arm is safe, but no weight bearing through the arm.

 

Weeks 8-12 post surgery:

  • Further strengthening and conditioning exercises of the elbow, forearm and wrist;

  • Gentle weight-bearing conditioning exercises will commence.

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Return to activity:

  • Once the bone has sufficiently healed, weight-bearing through the arm can increase gradually, but limited to no greater than 5kg through the arm long term. Sport should also be avoided long-term.

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Things to look out for:

  • Continued drainage from the wounds that does not stop after 1 week;

  • Sudden deterioration in pain levels when previously the pain had been improving;

  • Sudden locking of the elbow and inability to bend/straighten or rotate the forearm;

  • If any of the above is noted, please contact Kemble's team.

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Possible Complications

  • Ulnar nerve irritation or injury;

  • Elbow Stiffness

  • Wearing out of the artificial elbow joint

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