Elbow Joint Replacement

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Synonyms: total elbow arthroplasty, endoprosthetic elbow replacement

Unlike hip and knee joint replacements, which are performed thousands of times per year within the NHS, elbow joint replacement is a more recent and much less common operation. Although the number performed remains small it is regarded as a well-established surgical procedure. However, not all orthopaedic units will perform this surgery.

Surgical techniques to reconstruct or replace the elbow joint are becoming increasingly effective. Debridement techniques, including open or arthroscopic Outerbridge-Kashiwaghi procedure, often delay joint replacement. Implants for joint arthroplasty focus on the ulna-humeral joint; however, there is a trend towards total joint replacement including the radiocapitellar joint[1].

A total elbow replacement is made up of metal and plastic parts and replaces the joint between the humerus and ulna. There are two metal stems that fit into the bone cavity of the upper and lower arm and these are usually fixed into place by using bone cement. The two metal stems are either linked (like a hinge) or unlinked, depending on the type of replacement[2].

Joint replacement surgery is performed when other interventions, medical and surgical, will not offer a satisfactory outcome. Underlying pathology includes:

  • Osteoarthritis.
  • Rheumatoid arthritis (RA).
  • Complex fracture of the elbow, even in the elderly.
  • Severely damaged or torn soft tissues in the elbow, resulting in instability.
  • Malignancy in or around the elbow.
  • Poor results from previous elbow surgery.

Amongst those who get severe damage to the elbows are haemophiliacs[6]. Osteoarthritis follows recurrent haemarthrosis. Anyone who has taken blood from a person with haemophilia will have noticed that extension of the elbow is usually well short of 180°.

Indication for operation can be summarised as severe pain with radiological changes of joint destruction in the presence of failed conservative treatment. The most common underlying pathology is RA. Before operation the disease process of the RA should be under control.

This is as for most surgery. PA and lateral X-rays of the joint are required and the usual blood tests are performed. In elderly patients the routine will include CXR and ECG. Those with haemophilia will need appropriate boosting of factor VIII.

There are risks attached to any form of surgery:

  • Haemorrhage.
  • Infection.
  • Thromboembolism - less common with upper limb surgery.

There are specific risks to this operation:

  • Nerve damage during surgery, especially the ulnar nerve.
  • Blood vessel damage during surgery.
  • Fracture of bone during surgery.
  • Dislocation of the prosthesis.
  • Loosening of the implant over time.
  • Allergic reaction to the implant.
  • Fracture of the prosthesis. This is uncommon but if it occurs, results of revision surgery are reasonably satisfactory[8].

The patient will stay in hospital for about three or four days. A splint may be used after surgery to help stabilise the elbow.

  • Physiotherapy starts with gentle flexing exercises. Patients who have a splint typically start therapy a few weeks later than those who do not.
  • The patient will need help with everyday activities, such as driving, shopping, bathing, meal preparation and household chores, for up to six weeks.
  • Some patients may begin to regain function of the elbow as soon as 12 weeks after surgery, although additional recovery can take up to a year.
  • The patient should not lift more than about 2.5 kg with the arm which has had the surgery, even when fully recovered.

There has been criticism of joint replacement surgery because of poor comparisons between the various types of prostheses that are commercially available. There is now a national joint register for England, Wales and Northern Ireland[2]. A similar register is under consideration in Scotland.

Elbow replacement surgery provides good to excellent results for most patients[9].

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Original Author:
Dr Richard Draper
Current Version:
Dr Colin Tidy
Peer Reviewer:
Dr John Cox
Document ID:
3898 (v26)
Last Checked:
15 February 2017
Next Review:
14 February 2022

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.