Total Elbow Replacement
The elbow is a hinge joint consisting of three bones. The upper part of the
hinge is at the end of the upper arm bone (humerus), and the lower part of the
hinge is at the top of the two forearm bones (radius and ulna) which are side by
side. When the elbow is bent, the ends of the two forearm bones rub against the
end of the humerus.
Bones of Elbow Joint
In a healthy elbow joint, the surfaces of these bones are very smooth and
covered with a tough protective tissue called cartilage. Arthritis causes damage
to the bone surfaces and cartilage where the three bones rub together. These
damaged surfaces eventually become painful.
Arthritic Elbow Joint Surfaces
There are many ways to treat the pain caused by arthritis. One way is total
elbow replacement surgery. The decision to have total elbow replacement surgery
should be made very carefully after consulting your doctor and learning as much
as you can about the elbow joint, arthritis, and the surgery.
In total elbow replacement surgery, an artificial hinge made of metal and a very
durable plastic material is inserted into the joint so that the elbow can move
without allowing the two forearm bones to contact the humerus. We call this
artificial hinge an "implant."
Getting to the Joint
The patient is first taken into the operating room and given anesthesia. After
the anesthesia has taken effect, the skin around the elbow is thoroughly
scrubbed and sterilized with an antiseptic liquid. A tourniquet is then applied
to the upper portion of the arm to help slow the flow of blood.
An incision is then made over the elbow joint. The incision is gradually made
deeper through muscle and other tissue until the bones of the elbow joint are
Preparing the Bones
One of the forearm bones, the ulna, has a projection at the end, which extends
up and behind the end of the humerus. A special power saw is used to remove part
of this projection.
This allows the two forearm bones to be rotated out of the way so parts of the
humerus can be removed with the saw. Precision guides are used to help make sure
that the cuts are made so the bones will align properly after the implant is
The middle portion at the end of the humerus is removed first.
The arm bones have relatively soft, porous bone tissue in the center. This part
of the bone is called the "canal." Special instruments are used to clear some of
this soft bone from the canal of the humerus. These instruments also help shape
the canal to fit the shape of the implant.
Then, similar instruments are used to clear some of the soft bone and shape the
canal of the ulna.
Attaching the Implants
The elbow implant consists of two metal stems that are connected by a metal
locking pin. This pin passes through the ends of both stems, which are lined
with a strong plastic material, serving as a bearing that allows the elbow to
bend. The stems are inserted into each of the two prepared canals. A special
kind of cement for bones is first injected into the canals to help hold the
stems in place.
When the cement is hard, the two implant parts are brought together and the pin
is inserted to connect them.
Stems Locked Together to Create Hinge
Closing the Wound
If necessary, the surgeon may adjust the ligaments that surround the elbow to
achieve the best possible elbow function.
When all of the implants are in place and the ligaments are properly adjusted,
the surgeon sews the layers of tissue back into their proper position. A plastic
tube may be inserted into the wound to allow liquids to drain from the site
during the first few hours after surgery. The edges of the skin are then sewn
together, and the elbow is wrapped in a sterile bandage. Finally, the patient is
taken to the recovery room.