When we think about performing tasks with the upper extremities, what usually comes to mind is our hands and wrists. But without the elbow, so much of what you do each day would be impossible. The elbows are vital to some of the daily tasks we perform including picking up objects, washing your hair, or anything that requires you to turn your palm up or down. If you are experiencing elbow pain or other joint mobility from arthritis or bone fractures, don’t hesitate to contact the caring and experienced orthopedic specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado, to see if you are a candidate for elbow arthroplasty. In the right hands, elbow arthroplasty can greatly improve the quality of life for many people.
OVERVIEW
Elbow replacement surgery (sometimes referred to as total elbow arthroplasty (TEA) is a procedure used to replace some or all of a joint. Elbow arthroplasty is performed for the most debilitating pathologies in which the elbow joint is extensively damaged. It is used to relieve pain and restore motion to a seriously damaged elbow. Elbow replacement surgery or elbow arthroplasty does not always involve the entire elbow. In some people, only part of the joint is replaced. Although elbow joint replacement is much less common than knee, hip, or shoulder replacement, it is just as successful in relieving joint pain and returning people to daily activities. The ideal patient is older than 60 years and has a low functional demand. It is also used in selected cases of debilitating arthritis in young people.
ABOUT THE ELBOW
The elbow is a complex joint where the humerus bone of the upper arm connects with the bones of the lower arm (the ulna and radius). These bones are cushioned by articular cartilage, which keeps them from rubbing together while in motion and allows them to move freely. Smooth tissue called the synovial membrane also creates a fluid to help lubricate the joint. The “funny bone” is the protrusion at the end of the ulna known as the olecranon. The elbow joint is stabilized by ligaments at the front, back, and sides. Muscles and tendons in the joint enable one to bend and straighten the arm and rotate the forearm without moving the upper arm. The ulnar nerve runs through the elbow and into the forearm, along with a network of vital blood vessels.
WHAT IS WRIST ARTHROPLASTY?
In total elbow replacement surgery, the damaged part of the humerus and ulna are replaced with artificial components. The artificial elbow joint (implant) is made up of a metal and plastic hinge with two metal stems. The stems fit inside the hollow part of the bone called the canal and matches the contours of the patient’s body. Elbow replacements can be done in two ways:
linked implant or unlinked implant. (most in the US are linked)
- Linked implant: A metal stem is implanted, or anchored, in the upper arm bone (the humerus). Another metal stem is implanted in the ulna, which is one of the two bones in the forearm. After the implants are cemented in place, the stems are connected with a hinge in the elbow.
- Unlinked implant: The two implants are placed the same way as they are in the linked procedure. However, they are not connected with the hinge. They are held in place with the muscles, ligaments, and other natural parts of the elbow.
There are drawbacks and advantages to both types of replacement. The hinge in the linked implant may become stretched and loose over time. That’s why there are lifting restrictions after surgery. An unlinked implant requires the ligaments, muscles, and tissues of the elbow to be in good shape. If they are damaged, then the joint will be unstable. Physical therapy is a critical part of keeping the muscles and tissues strong and stable. Research shows that older adults who experience severe fractures often do better with an elbow arthroplasty than with the traditional plates and screws used to repair a broken bone. Older bones are often more fragile and the bone quality may not be good enough to hold the joint together.
CAUSES
An elbow injury (severe fracture) is the most common reason why a person would need elbow arthroplasty. Severe cases of rheumatoid arthritis come in second. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis”. Osteoarthritis is primarily age-related wear-and-tear. Posttraumatic arthritis can follow a serious elbow injury. When the elbow hits a surface after the body has been speeding through space—such as falling from a bike or scooter or on a basketball court—one may sustain a fracture of the ulna or radius of the upper arm, a dislocation (where the elbow comes out of alignment) or a tear of the soft tissues that surround the bone. Falling on an icy sidewalk or from a high height off a ladder are other common causes of elbow injuries. Poor outcomes from past elbow surgeries can be a cause, also, an elbow tumor.
SYMPTOMS
- Extreme joint pain
- Decreased range of motion
- Loss of function –difficulty performing everyday functions such as lifting, carrying, or reaching
- Swelling
- Bruising
- Instability
- Stiffness in and around the elbow
- Snap or pop at the time of injury
- Visible deformity
- Numbness or weakness
- Joint damage
NON-SURGICAL TREATMENTS
Rest, ice therapy, NSAID pain medications such as ibuprofen, cortisone injections, and physical therapy are most common. Splints and slings are used when injuries are less serious and do not require surgery but are needed to keep the elbow immobilized and protect soft tissues post-operatively.
WHEN IS SURGERY INDICATED?
If, after several months of more conservative treatments the elbow problem fails to improve, a surgeon may recommend the most appropriate surgery. In some cases, one may need a replacement of just one portion of the joint. For example, if only the head of one of the forearm bones, the radius, is damaged, it can be replaced with an artificial radial head. When the entire joint needs to be replaced, the ends of the bones that come together in the elbow are reshaped. Bones are hard tubes that contain a soft center. The long, slender ends of the artificial parts are inserted into the softer central part of the bones. The parts are usually attached with bone cement. If the surrounding ligaments aren’t strong enough to hold the joint together by themselves, the surgeon may use a linking cap. This connects the artificial implants so they can’t come apart.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Gauging the degree of damage is the first step in determining a treatment plan for someone who needs elbow arthroplasty. After a thorough physical exam and review of your symptoms, X-rays and often a CT scan will be ordered to rule out possible fractures or in the case of CT scans show damage to soft tissues. Even though patients experience good results with current procedures used by other surgeons, at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, their exceptional orthopedic specialists keep working to make the future care of their patients a priority. They consistently embrace new technologies in elbow arthroplasty and stay on the cutting edge of the significant strides being made in prosthetic elbows that make them more durable and effective solutions for their patients. They are also always at the forefront of improved surgical techniques that provide better outcomes. Elbow arthroplasty is a highly technical procedure and is best performed by surgeons who perform this procedure regularly such as the immensely skilled and supportive doctors at Advanced Orthopedics. For the best overall experience and results, you can’t do better.
