Total Elbow Arthroplasty

What is an elbow replacement arthroplasty?

Elbow replacements can be either partial or complete. The elbow consists of two joints: the radio capitellar joint and the ulnohumeral joint. The radio capitellar joint is what allows patients to rotate their wrists. The ulnohumeral joint allows for flexion and extension of the elbow. Both joints can be involved in elbow replacement arthroplasty.

An elbow replacement arthroplasty involves replacing either or both the radio capitellar joint or the ulnohumeral joint. Replacing the radio capitellar joint is referred to as a radial head replacement and replacing the ulnohumeral joint is referred to as a “total elbow.” Elbow replacements are very similar to knee and hip replacements. The damaged bone is removed, and a titanium or stainless-steel stem is placed in the canal. The joint is recreated with high molecular weight polyethylene plastic that allows for articulation.  Typically, cement is used for a “total” elbow with implants in both the humerus and the ulna. In a radial head replacement, only the radial head is replaced, and cement may not be necessary.

Why is elbow replacement arthroplasty performed?

Elbow replacement arthroplasty is performed for either arthritis or fractures.

Radial head fractures are a common injury that occurs from a fall on an extended elbow and an outstretched wrist. They can occur from skiing, mountain biking, simple falls, and high energy trauma. Many radial head fractures are non-displaced and heal well without surgery. However, in high energy injuries, the radial head can be broken in many pieces or “comminuted.” These comminuted fractures are often fixed with plates and screws. However, some radial head fractures cannot be pieced back together, and a radial head implant arthroplasty is performed.

Distal humerus fractures also occurs from a fall or high energy trauma. Distal humerus fractures can also be comminuted and involve the joint surface. In younger people, these can often be fixed with plates and screws. However, in older people, the fracture pattern and bone quality is often such that a total elbow arthroplasty is performed.

The desire in all fracture situations is to fix the fracture when possible but in some settings an elbow implant arthroplasty results in better function.

The other indication for elbow replacement arthroplasty is rheumatoid or osteoarthritis. Conservative treatment such as rest, splints, anti inflammatories and injections are often tried first. When these fail, total elbow arthroplasty can be considered. Patients with rheumatoid arthritis often do well with total elbow implant arthroplasty because the demand on the elbow tends to be lower. In osteoarthritis, the indications for total elbow implant arthroplasty are limited. The procedure can only be done in lower demand patients to prevent loosening of the implant. Heavy laborers, athletes and high demand individuals are often not candidates for total elbow implant arthroplasty. Dr. Kavi Sachar will evaluate you and determine if you are a candidate for total elbow implant arthroplasty or if another procedure is better for you.

Recovering from elbow implant arthroplasty

The surgical procedure is typically done as an outpatient procedure under both a regional and general anesthetic. The arm is immobilized for less than one week and therapy is started to work on range of motion and strengthening. Most patients resume daily activities quickly and normal activities within 3 months. Some limitations may be placed on the patient after surgery. With a total elbow implant arthroplasty, there are often weightlifting limits to prevent loosening of the implant. Dr. Kavi Sachar will discuss these limits with you based on the procedure that is performed.

Schedule a consultation

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