Total elbow replacement (elbow arthroplasty) is an operation to replace the damaged surfaces of the elbow joint with artificial components. It is most commonly performed for severe rheumatoid arthritis, complex fractures in older patients, or failed previous surgery.
An incision is made at the back of the elbow. The damaged joint surfaces are removed and replaced with metal and plastic components fixed into the humerus (upper arm bone) and ulna (forearm bone). The components are usually linked together and cemented into place. The ulnar nerve is identified and protected throughout. The operation typically takes one and a half to two hours.
Elbow replacement is considered for severe inflammatory arthritis (such as rheumatoid arthritis), complex distal humeral fractures in older patients where fixation is unlikely to succeed, post-traumatic arthritis, and revision of previous failed surgery.
Disease-modifying medication for rheumatoid arthritis, pain relief, physiotherapy, corticosteroid injections, and activity modification. For fractures, non-operative treatment or fixation may be alternatives depending on the pattern.
Thorough pre-assessment including medication review. Patients on immunosuppressive drugs for rheumatoid arthritis may need to adjust these before surgery. Plan for limited arm use for several weeks.
The primary goal is pain relief and restoration of functional elbow movement. Most patients experience excellent pain relief. The replaced elbow allows comfortable use for daily activities but has a permanent lifting restriction, typically limited to around 5 kg repetitively.
A permanent weight-lifting limit of approximately 5 kg to protect the implant from early loosening.
Temporary numbness or tingling in the ring and little fingers is common after surgery.
Expected around the elbow in the early weeks.
Elbow replacement has a higher infection rate than hip or knee replacement, approximately 3–5%. Deep infection may require removal of the implant.
The components may loosen over time, particularly with excessive loading.
Permanent nerve damage is uncommon but can cause weakness and numbness.
The skin over the elbow is thin and more prone to healing difficulties.
Fracture around the implant, more common in patients with weak bone.
Weakness of the muscle that straightens the elbow. Usually recovers.
Performed under general anaesthesia, usually with a regional nerve block for post-operative pain relief.
The arm is elevated and supported after surgery, usually in a back-slab or light splint for a few days. Gentle movement begins early. Most patients stay in hospital for one to two nights. A physiotherapy programme guides gradual return of movement and function. The permanent lifting restriction must be observed to protect the implant. Driving is usually possible at six to eight weeks.
Wound check at two weeks. Surgeon review with X-rays at six weeks, three months, and one year. Long-term follow-up is important to monitor the implant.
Elbow replacements experience high forces during lifting. Exceeding the limit accelerates wear and loosening. The 5 kg limit applies to repeated lifting; occasional heavier loads may be acceptable.
With careful use, an elbow replacement typically lasts 10–15 years. Revision surgery is possible but more complex than the primary procedure.
Yes, but the operations are done at separate times to allow recovery from one before proceeding with the other.