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Modern elbow replacemen­ts provide a solution for many

- Mayo Clinic Mayo Clinic Q&A is an educationa­l resource and doesn’t replace regular medical care. Email a question to MayoClinic­Q&A@ mayo.edu.

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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