Modern elbow replacements provide a solution for many

Q: I have bad arthritis in my elbow. After several failed surgeries, I have been told that my only option is elbow replacement. I’ve heard others say that elbow replacements do not work. Does Mayo Clinic have experience with elbow replacements? A: Traditionally, elbow replacement has been reported to lead to complications more often than replacements of other joints, like the hip or knee. However, modern elbow replacements provide a reliable solution for many patients, and the complication rate with Mayo Clinic patients has decreased.

Make sure your elbow is ready for replacement. Pain and motion in arthritic elbows can be improved using a procedure called arthroscopic osteocapsular arthroplasty, where a camera is inserted in the joint and instruments are introduced to clean the joint. This procedure allows the surgeon to remove bone spurs, fragments of bone or cartilage and inflamed tissue.

Unfortunately, in many circumstances the elbow is severely damaged. Elbow replacement is the best option in these cases.

Three bones form part of the elbow joint: the arm bone, also known as the humerus; and the two bones in the forearm, the radius and ulna. The ulna and the humerus form a hinge-like joint for elbow bending and straightening. The radius supports the wrist and helps the palm of the hand rotate up and down. Elbow replacements provide a new joint between the humerus and the ulna. Typically, the procedure is performed under general anesthesia through an incision in the back of the elbow. The bones in the elbow are prepared to receive the implants, which are fixed with bone cement. A high-quality plastic liner forms the new joint against metal. Once the wound is healed, it takes about three months of physical therapy to restore elbow motion, and most patients’ pain resolves. Complications include infection, nerve injury, tendon injury and implant wear or loosening.

Infection is particularly worrisome in people with rheumatoid arthritis who take medications that affect the immune system. It is also a concern when replacement is performed in elbows that already have been operated on several times. Efforts made to prevent infection include careful evaluation of the elbow for possible occult infection, use of antibiotics in the wound and meticulous care of the wound.

To access the elbow joint, the triceps muscle or tendon oftentimes is detached from the bone or divided at the time of replacement. The triceps is reattached or repaired at the end of the procedure, and it heals in most, but not all, patients. When the triceps does not heal, patients may feel weakness with activities that require extending the elbow, such us opening a door or holding objects overhead. There are developing alternatives to deal with the triceps to minimize weakness.

Elbow implants are mechanical devices that are subject to wear and tear after years of use. Common sense would suggest avoiding use of the replaced elbow for high-demand activities, such as weight training or hard manual labor.

The good news is that people who suffer with pain and stiffness due to severe elbow arthritis are seldom disappointed with the results of elbow replacement: Pain goes away, and movement allows most activities to be performed. An elbow replacement can provide significant improvement in quality of life from the effects of arthritis. — Joaquin SanchezSotelo, M.D., Ph.D., Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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