The previous incision is reopened. The ulnar nerve is identified and protected (or transposed if not already done). The existing components are removed — this may require bone windows, osteotomies, or specialised extraction instruments, particularly for well-cemented stems. Cement is removed from the humeral and ulnar canals. Bone defects are assessed and may require strut allografts, impaction grafting, or mesh reconstruction. Longer-stemmed revision components are implanted. The operation takes two to four hours.
Revision is needed for aseptic loosening, infection (after DAIR failure), polyethylene bushing wear, instability, periprosthetic fracture, and implant fracture.
For loosening: observation if minimally symptomatic. For infection: long-term antibiotic suppression. For pain: analgesics and splinting. Resection arthroplasty (removing the prosthesis without reimplantation) is a salvage option.
CT for bone stock assessment. If infection suspected, aspiration. Identification of existing implant type. Specialist revision components and instruments must be available.
Restoration of elbow function and pain relief. Outcomes are less predictable than primary elbow replacement and complication rates are higher.
Ulnar nerve dysfunctionCommon
The nerve is at significant risk in revision surgery. Approximately 10–20%.
Reduced range of motionCommon
Less motion than after primary replacement.
Wound healingCommon
Previously operated tissue is vulnerable.
Intraoperative fractureUncommon
During component removal. Risk approximately 5–10%.
InfectionUncommon
Higher risk than primary. Approximately 5–10%.
Implant failureLong-term
Revision components have shorter survivorship.
Triceps weaknessCommon
From repeated surgical exposure.
Bone lossExpected
Progressive with each revision.
General anaesthesia. Prolonged operating time.
Splint for two to four weeks. Gentle exercises from one to two weeks. Progressive strengthening from six weeks. Lifelong activity restrictions (no more than 1 kg repeated lifting, 5 kg single lift). Full recovery three to six months.
Reviews at two weeks, six weeks, three months, and annually long-term.
How many times can an elbow be revised?
Each revision becomes progressively more difficult with less bone stock. Most patients can undergo one or two revisions, but salvage options (resection arthroplasty or arthrodesis) may eventually be needed.