Elbow Replacement Arthroplasty

What is elbow replacement arthroplasty?

Elbow replacement arthroplasty is when some or all of the elbow is replaced with an artificial joint that has stems and plastic to create a new elbow articulation. There are two joints that can be replaced: the ulnohumeral joint with allows for flexion and extension and the radial head which allows for rotation.

Why is an elbow replacement arthroplasty performed?

Elbow replacement arthroplasties are performed for either arthritis or trauma. Either a partial or total elbow replacement is performed based on the condition.

What is Arthritis?

Arthritis can be divided into osteoarthritis and inflammatory arthritis. Osteoarthritis is commonly referred to as degenerative or “wear and tear” arthritis. Inflammatory arthritis is considered an autoimmune disease where the body attacks itself. Common examples of inflammatory arthritis are rheumatoid arthritis, lupus, gout, scleroderma, and psoriatic arthritis.

How does arthritis occur?

In osteoarthritis, articular cartilage degenerates and results in weakening of the cartilage and eventual death of cartilage. Cartilage is the smooth gliding surface between bones.  Dr. Kavi Sachar likes to think of it as two sheets of ice with fluid in between acting as a lubricant. In osteoarthritis, this “ice” melts and patients are eventually left with the bones rubbing against each other like two pieces of concrete. This can result in pieces of bone breaking off and the bone softening and collapsing. Osteoarthritis is divided into 4 stages based on x rays.

• Grade 0: Normal appearing joint with no cartilage loss
• Grade 1: minor Joint space narrowing with small bone spurs
• Grade 2: definite joint space narrowing with bone spurs
• Grade 3: moderate joint space narrowing with large bone spurs and possible deformity
• Grade 4: severe joint space narrowing with bone-on-bone contact, large bone spurs and deformity

Inflammatory arthritis occurs when the body attacks itself. This is considered a systemic disease that can affect not just joints, but organs, ligaments, and other tissue as well. Each form of inflammatory arthritis is different and often requires a medical doctor or rheumatologist to be involved in management and treatment.

Diagnosing arthritis

Both osteoarthritis and rheumatoid arthritis may present with pain and swelling. Patients will have difficulty with activities such as lifting and twisting. They may notice weakness and may frequently drop things. Typically, rheumatoid arthritis may be more painful in the morning whereas osteoarthritis may get worse as the day goes on.

In the elbow arthritis,  patients may notice swelling. The elbow may have decrease motion. There may be a history of a fracture in the past, such as a radial head fracture, that may not have healed resulting in altered biomechanics that leads to osteoarthritis.

Non-surgical treatment of arthritis

When treating arthritis, Dr. Kavi Sachar likes to describe a spectrum of treatment that ranges from conservative treatment to surgery. Many conservative treatments may be offered because patient response can be variable. Sometimes, the simplest treatment may work, helping to avoid surgery.  Conservative treatment consists of rest, splint immobilization, anti-inflammatory, therapy, cortisone injections and biological injections. There are some holistic remedies such as diet modification that can help some patients (link to arthritis sheet).  Therapy can help build the muscles and help strengthen the joint. Cortisone injections can temporarily help with the pain. Platelet Rich Plasma (PRP) is a treatment where a patient’s own blood is drawn, and the platelets are concentrated via centrifuge to isolate Platelet Derived Growth Factor which can help in tissue healing. Favorable results have been reported in some patients.

In the elbow, conservative treatment of arthritis often involves bracing and activity modification. Therapy can help build strength around the wrist. Selective corticosteroid injections can both help with treatment and to help establish the diagnosis. Elbow arthroscopy can be used to remove loose bodies and arthritic bone spurs. Elbow replacement arthroplasty is considered when conservative treatment fails.

What fractures can result in elbow replacement arthroplasty?

Radial head fractures can occur from a fall or direct trauma to the elbow. These fractures can vary from nondisplaced to displaced and comminuted which means in many pieces. Non displaced and fractures with a few fragments can often be fixed with plates and screws. However, severely comminuted and displaced fractures may require radial head replacement.

Distal humerus fractures are often referred to as supracondylar humerus fractures. As with radial head fractures, many can be fixed with plates and screws. However, severely comminuted fractures specifically in osteoporotic bone may require elbow replacement arthroplasty.

How is elbow replacement arthroplasty performed?

The surgical procedure is performed as either an inpatient or outpatient procedure depending on the complexity of the surgery. The damaged or fractured portion of the bone is removed and an artificial joint is inserted. Sometimes this requires cement to hold it in place. Patients are placed in a splint and immobilized short term to control swelling.

Recovering from elbow replacement arthroplasty

After short term immobilization to control swelling, motion is started.  Patients gradually increase their range of motion and strength and are usually allowed to resume activity by 6 weeks. In a total elbow replacement arthroplasty, you may be given a weight limit to decrease the risk of implant loosening. Dr. Kavi Sachar will discuss this with you before the decision for surgery is made.

Schedule a consultation

Board-certified and fellowship-trained hand surge Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on arthritis. Dr. Sachar has three office locations in Vail, Aspen and Frisco, Colorado. If you or a family member has suffered arthritis, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.