| Elbow arthroplasty is a surgical procedure designed to either restructure the elbow joint or replace a diseased or seriously injured elbow joint with an artificial device made of metal and polyurethane (prosthesis).
Two types of arthroplasty are performed: resection and total replacement. Resection arthroplasty removes a portion of or the entire elbow joint and is used to manage joint immobility from trauma or infection or after failure of a total elbow replacement. Resection procedures include limited, functional, and interpositional arthroplasty. These procedures differ from each other in the extent of surgical repair and the specific surgical technique used.
Total replacement arthroplasty replaces both sides of the elbow joint (lateral, proximal) with prostheses. The ideal candidate for this procedure is older than age 65 with low physical demands. High demands on a prosthesis can lead to implant loosening and/or failure. Also, there is a higher device failure rate after 10 years of implantation. First- line treatment for younger individuals with elbow joint damage is an interpositional arthroplasty. |
Source: Medical Disability Advisor
| The primary indications for elbow arthroplasty are pain, joint instability, and limited range of motion. These procedures are performed to relieve pain and restore function and stability associated with degenerative osteoarthritis, end-stage rheumatoid arthritis, juvenile rheumatoid arthritis, or post-traumatic arthritis when the elbow has failed to respond to medical treatment. Elbow arthroplasty occasionally is used to treat severely fractured elbows.
Limited resection arthroplasty is performed on individuals with minimal damage to the elbow. Although rarely used, complete resection arthroplasty and functional resection arthroplasty are reserved for individuals with more extensive joint damage or severe joint infection. Interpositional arthroplasty is used to treat individuals who experience chronic pain, who have failed to achieve adequate range of motion, and whose joint (articular) surface is more than 50% damaged. Total joint replacement is used to treat individuals with severe pain and weakness caused by joint instability or those who have elbow immobility and fusion of the joint (ankylosis).
Because limited and interpositional arthroplasties are less traumatic to the joint and for the individual, they may be preferred over total replacement arthroplasty. In some cases, resection arthroplasty may be tried first and then, if not successful, total replacement arthroplasty may be performed. In general, resection arthroplasty is reserved for younger individuals and total replacement arthroplasty for older individuals. |
Source: Medical Disability Advisor
| Elbow arthroplasty procedures usually are performed under general anesthesia. The individual lies on the back (supine) with the target arm positioned at a 90° angle across the chest. The surgeon makes an incision in the back of the upper and lower arm exposing the affected joint, taking care to avoid damage to the ulnar nerve.
Complete resection arthroplasty removes the entire elbow joint, leaving it nonfunctional. Interpositional arthroplasty attempts to preserve the functional stability of the joint and reduce the likelihood of joint immobility or stiffness by placing tissue (e.g., muscle, fat, skin, or tendon) between the bones that make up the joint. Before the interpositional membrane is placed, the joint surface may require reconstruction to smooth out abnormal bone elements, insert screws or bone grafts, or relocate the ulnar nerve to avoid later nerve entrapment, pain, and weakness.
Once surgery is complete, a threaded pin (distraction device) placed through the elbow joint may remain in place during the first 3 to 4 weeks following the procedure to aid in preserving the range of motion achieved on the operating table.
In total replacement arthroplasty, the elbow joint end of the upper arm bone (humerus) and the inner forearm bone (ulna) are removed and channels are drilled into the center of the bones. The prosthetic devices are then cemented into the channels to form a new joint. Several types of joint prostheses are available, specifically designed to provide full mobility (unconstrained), some mobility restrictions (semiconstrained), or no mobility (constrained). The choice of device depends on the extent of the disease process and its etiology (trauma, osteoarthritis, post-traumatic arthritis, or rheumatoid arthritis), specific needs of the individual, and the experience of the surgeon. Following any type of arthroplasty, the elbow is immobilized in a straight (extended) or bent (flexed) position for a few days. Antibiotics and analgesics are prescribed as needed. |
Source: Medical Disability Advisor
| Elbow arthroplasty typically has a good outcome. Of the resection arthroplasties, interpositional arthroplasty has the best outcome. However, total replacement arthroplasty has a more favorable outcome than any of the resection arthroplasty procedures, with a success rate of about 80% 5 years after replacement (Wheeless). Almost all individuals undergoing total replacement arthroplasty experience relief of joint pain and improved elbow function; however up to 30% experience complications within 5 years, including nerve damage, infection, and long-term failure (Wheeless). |
Source: Medical Disability Advisor
| Note on research and authorship Individuals undergoing elbow arthroplasty require inpatient physical or occupational therapy for the days immediately following surgery. Swelling in the hand and forearm can be controlled if the individual wears a sling or elevates the hand on a pillow. Therapists should also encourage movement of the shoulder, wrist, and hand to decrease swelling during this initial period of immobilization.
The initial goals after surgery are to control pain and swelling by applying cold packs and elevating the operated arm, and to initiate movement of the prosthetic joint (Roos), and if indicated, active range of motion to the adjacent wrist and hand. Rehabilitation after an elbow arthroplasty depends on the surgeon's protocol and the type of prosthesis used. All protocols must be followed to protect the integrity of the joint and surrounding soft tissue. Usually 2 weeks postoperatively, individuals are guided in resuming simple activities of daily living tasks while protecting the elbow. At 6 weeks postoperatively, they may begin resistive exercises.
If the patient has difficulty gaining full extension, a resting extension splint can be applied when indicated. Lifetime restrictions (Moro) include lifting heavy objects and avoiding upper extremity impact sports. |
| FREQUENCY OF REHABILITATION VISITS | | Surgical ‡ | |
| Physical or Occupational Therapist | | Up to 40 visits in 26 weeks | |
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| ‡ Note on Surgical Guidelines: Although individuals may return to work, continued rehabilitation is necessary for full functional recovery. |
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Complications associated with any elbow arthroplasty procedure include superficial or deep infection, dislocation, fracture, joint instability, bone spurs (exostosis), triceps muscle weakness or rupture, collection of serum (seroma) or blood (hematoma) in the tissues, synovitis, and long-term failure (i.e., pain, joint stiffening, and joint instability). Damage to the ulnar nerve (ulnar neuropathy) can lead to arm weakness and burning, tingling or prickling sensations (paresthesia) in the arm. Loosening, breakage, or failure of the prosthesis are additional complications associated with total replacement procedures. |
Source: Medical Disability Advisor
| Individuals with jobs that require heavy lifting or strenuous activities involving the arm will need temporary reassignment to sedentary duties. The elbow may be immobilized during the recovery period, temporarily making the individual unable to operate equipment or perform other tasks that require use of both hands. If the dominant arm was affected, the individual may be unable to write legibly, type well, or perform activities that require fine motor skills such as those needed to work in a laboratory or on an assembly line. In general, individuals will have a permanent lifting restriction of 5 pounds (2.3 kg) for repetitive lifting and 10 pounds (4.5 kg) for a single lift with the affected arm. For individuals with positions that require heavy work and those who received a semiconstrained or constrained prosthetic joint, disability may be permanent necessitating a change in occupational responsibilities. |
Source: Medical Disability Advisor
| Moro, J. K., and G. L. King. "Total Elbow Arthroplasty in the Treatment of Posttraumatic Conditions of the Elbow." Clinical Orthopaedics and Related Research 370 (2000): 102-114. National Center for Biotechnology Information. National Library of Medicine. 23 Jul. 2008 <PMID: 10660705>.Roos, E. M. "Effectiveness and Practice Variation of Rehabilitation after Joint Replacement." Current Opinion in Rheumatology 15 2 (2003): 160-162. National Center for Biotechnology Information. National Library of Medicine. 23 Jul. 2008 <PMID: 12598806>. Wheeless, Clifford. "Total Elbow Arthroplasty." Wheeless' Textbook of Orthopedics. Eds. Nina Lightdale, Justin Field, and Christopher Danney. Durham: Medmedia.com, 1996. Wheeless' Textbook of Orthopaedics. Duke Orthopaedics. 23 Jul. 2008 <http://www.wheelessonline.com/o2/1607.htm>. |
Source: Medical Disability Advisor
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