What Is Total Elbow Replacement?
Your elbow is a hinge joint where three bones meet: the upper arm bone (humerus) and the two forearm bones (ulna and radius). Smooth cartilage covers the ends of these bones so they glide as you bend and straighten your arm and turn your palm up or down. When that cartilage is worn away by arthritis, or the joint is shattered by a severe fracture, the elbow can become painful, stiff and weak.
In a total elbow replacement, the surgeon removes the damaged bone ends and fits a metal stem into the upper arm bone and another into the ulna. The two parts are joined by a hinge, usually with a plastic bearing between them, so the elbow can bend and straighten again. Arthroplasty is the medical word for joint replacement surgery.
The new elbow is meant to relieve pain and restore a useful range of motion for everyday tasks. It is not designed for heavy lifting, and most people live with long-term lifting limits on that arm to protect the implant.
Performed at a hospital or surgery center where our surgeons operate, with evaluation, X-ray and MRI, follow-up visits and hand therapy here in our Boynton Beach office.
Who Is a Candidate?
You may be a candidate if you have:
- Severe elbow osteoarthritis, the wear-and-tear form of arthritis, with pain and stiffness that limit eating, grooming, dressing or reaching.
- Rheumatoid arthritis, an inflammatory condition that can destroy the elbow joint surfaces.
- Arthritis after an old injury or fracture (post-traumatic arthritis).
- Some complex fractures of the lower end of the upper arm bone in older adults, when the bone is broken into many pieces or is too fragile to repair with plates and screws.
- Symptoms that have not improved enough with non-surgical care, such as activity changes, therapy, bracing, medication when safe for you and injections.
Because the replacement carries lasting lifting limits, it usually fits people whose daily activities are light to moderate. Younger patients and people who do heavy manual work may be better served by other options first, such as elbow arthroscopy. Dr. Tucker will talk with you about your goals, your work and your health before recommending surgery.
What to Expect
Your evaluation includes an exam and X-rays in our Boynton Beach office, and sometimes an MRI. Dr. Tucker reviews the images with you, explains whether replacement or another approach fits your elbow, and goes over the lifting limits you would have afterward so you can decide with full information.
Surgery is done at a hospital or surgery center where our surgeons operate. Most patients receive general anesthesia, often with a nerve block that numbs the arm for pain relief after surgery. The surgeon works through an incision along the back of the elbow and protects the ulnar nerve, the funny-bone nerve, during the operation. Depending on your health and the facility, you may go home the same day or stay in the hospital for a night or two. You will leave with a splint or dressing that supports the elbow.
Risks and Side Effects
Total elbow replacement carries risks. These include infection, wound healing problems at the back of the elbow, irritation of or injury to the ulnar nerve or other nerves, stiffness, blood clots, fracture of the bone around the implant, and loosening or wear of the implant over time, which is more likely with heavy use of the arm. Some patients eventually need a second surgery, called revision, if the implant loosens or wears. Dr. Tucker will explain the steps used to lower your risks and what to watch for.
Recovery
Recovery varies. The elbow is usually protected in a splint or dressing for a short period while the incision heals, and then gentle motion begins. Dr. Tucker coordinates hand and occupational therapy in our office, where our therapists, including Elise Burger, OTR, guide you through motion exercises, help control swelling and teach you safe ways to do daily tasks. Many people return to light daily activities within a few months.
Most surgeons recommend lifelong limits on the replaced arm, such as avoiding heavy lifting, repetitive lifting and impact activities. Dr. Tucker will give you specific guidelines.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Total elbow replacement is usually covered by Medicare and most commercial PPO plans when it is medically necessary, often with prior authorization. HMO and managed-care plans require a referral from your primary care physician before your visit. Co-pays, co-insurance and deductibles apply. If your elbow problem is related to a work injury, we accept workers' compensation and coordinate treatment, documentation and return-to-work planning. Call our office and our team will verify your benefits.
When to Talk to a Specialist
Schedule an evaluation if elbow pain or stiffness makes it hard to eat, groom or dress, disturbs your sleep, or has not improved with several months of treatment. After an injury, go to the emergency room or call 911 if your elbow looks deformed, bone has come through the skin, or your hand is numb, cold or pale. After surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision. For other questions after hours, call our main office number to reach the answering service.
