Total elbow arthroplasty (TEA), also called total elbow replacement, is a surgical procedure that helps to relieve pain and maintain motion in an arthritic or injured elbow joint. There are 3 arm bones that make up the elbow joint: the humerus or the upper arm bone; the ulna, which is the lower forearm bone on the little finger side; and the radius that is the larger forearm bone on the thumb side (Fig.). TEA is an alternative treatment to elbow arthroscopy (surgery through small incisions in the skin), synovectomy (removal of the synovial tissue surrounding a joint) or internal fixation for traumatic injuries (a surgical procedure that stabilizes bones using devices such as metal plates, pins, rods, screws, or wires), and other motion preserving procedures. Depending on your age, condition, and activity level, your doctor may recommend TEA rather than other treatment options.

Why does my elbow hurt?

Elbow arthritis is caused by degeneration of the cartilage, producing a painful, stiff joint that can affect your quality of life. Whereas arthritis in the knee and hip often results from normal wear and tear of the joint due to aging, elbow arthritis most commonly occurs after trauma to the elbow, following a fracture about the elbow or chronic instability. Patients with rheumatoid arthritis can experience joint degeneration due to the inflammation in the joint. Only a small percentage of elbow arthritis arises from just wear and tear of the joint alone.

What is the treatment for elbow arthritis?

Initially, physicians treat elbow arthritis nonsurgically with anti-inflammatory medications, physical therapy, bracing, steroid injections, and orthobiologics. If these nonsurgical treatments fail to provide pain relief and the arthritis continues to affect your ability to do everyday activities, there are surgical options to consider. Some alternative surgical treatments to help relieve your pain include: elbow arthroscopy to remove debris; ulnohumeral interposition arthroplasty involves surgically adding new tissue between the damaged surfaces of the elbow joint; elbow fusion that permanently fuses the joint together; or joint replacement.

Elbow fusion is rarely performed or recommended because although it provides pain relief, it eliminates motion at the joint. Therefore, an elbow fusion can severely limit a patient’s ability to perform daily activities, such as personal hygiene. Elbow arthroscopic treatments may be an additional option, but these procedures may only temporarily relieve pain. TEA gives patients another option in managing painful and debilitating elbow arthritis.

What is total elbow arthroplasty (TEA)?

The goals of TEA are to alleviate pain and regain range of motion, to help improve your quality of life. Surgeons perform TEA by removing arthritic cartilage and bone from the elbow joint and replacing it with metal and plastic components. Additionally, this allows patients to perform activities of daily living they would not have been able to do otherwise. A downside of TEA is the restriction of weight lifting on the operated extremity to 5 to 10 pounds indefinitely.

Am I a candidate for TEA?

If you have painful arthritis and nonsurgical treatment has failed, you may want to talk to your doctor about TEA. You are a good candidate for elbow replacement if you have maintained elbow motion but continue to have severe pain or instability despite nonsurgical care. Typically, older patients over the age of 65 with less demand on their arms are good candidates for surgery. However, every patient is unique; therefore, your doctor will evaluate you and consider your goals and lifestyle to determine your best course of treatment.

TEA is not recommended if you have an active or prior infection in the elbow joint, inadequate bone to support the implants or neuromuscular disease that impairs muscles resulting in poor muscle tone and function around the elbow. Additionally, it is not recommended in active patients younger than the age of 65 and in patients who have had a prior olecranon osteotomy, a surgical procedure to the elbow’s outer bony prominence.

How is the surgery performed?

Orthopaedic surgeons typically perform the TEA using general anesthesia. A nerve block to the upper extremity can be used as a supplement to aid in postoperative pain control. The doctor places a tourniquet around the upper arm to help control bleeding and improve visualization during surgery. The surgeon makes an incision on the back of the arm, over the elbow joint. Once dissection is performed, the humerus and ulna bones are prepared for the implants by removing the abnormal, damaged bone. The surgeon then prepares the bones, which allows for placement of the metal and plastic components to recreate the elbow joint. After the implants are placed, the surgeon tests the range of motion of the elbow. Next, the incisions are closed with sutures or staples and the elbow is placed into a well-padded splint.

What happens after surgery?

After surgery, you may be discharged the same day or spend the night in the hospital. After you go home, your physician will give you a strict regimen to keep the arm elevated and to perform finger range of motion exercises to help with swelling and improve wound healing. You will remain nonweightbearing in the splint for 2 to 4 weeks. At around 2 weeks, you will have the splint and sutures removed. Following surgery, there is a life-long weight lifting restriction of less than 10 pounds. Therapy will be initiated following surgery, focusing on range of motion. Physical therapy protocols can vary depending on your surgeon’s preference.

What are the potential complications?

In general, problems that can arise from any surgery include infection, blood loss, and anesthesia related complications. Wound healing can be a problem, especially in higher-risks patients who are diabetic or have a peripheral vascular disease (poor circulation) and those who continue to smoke. Complications specific to TEA include loosening of the implants, wound healing problems, instability of the components, nerve injury, and fracture around the implants. As in all total joint replacements, the plastic component between the metal devices can wear out, which could result in loosening of the implant from the bone. This typically requires revision surgery to replace the implants. Implant failure can result if the bone fails to heal to the metal components.

What are the typical outcomes of TEA?

Patients typically have pain relief and maintain range of motion after TEA. For specific patients TEA has good outcomes, often with 90% experiencing a 10-year implant survival rate. Even with the possibility of complications, TEA implants continue to evolve and outcomes are improving.

 

Authors: Devin Collins, DO and David C. Rehak, MD | Columbus, Georgia

Vol 32, Number 3, Summer 2020

Health Alert Catalog

Last edited on October 18, 2021