Many people know someone who has had a knee or hip replacement. They are very common. Far fewer people know someone who has had their elbow replaced. Elbow arthritis occurs far less frequently than knee and hip arthritis. Hence the disparity, Recently elbow replacements have become even more rare.
In years past, patients with rheumatoid arthritis were the primary driver of elbow replacement rates. But fewer people with rheumatoid arthritis get elbow replacements today because the rheumatoid arthritis medications work so well at preventing the disease from advancing to the point of total joint destruction. The need for elbow replacement still arises.
But, since elbow replacements are performed less frequently than other joint replacements it may be difficult to find a surgeon familiar with the procedure. This is something to be aware of if you are considering this operation.
Elbow replacements come with unique risks
Do me a favor. Straighten out your arm. Now pinch the skin on the back of your elbow. Now bend your elbow.
Now you have an idea how little tissue lies between the air and the tip of your elbow bones. Not much.
Soft tissues like muscle and tendon act like a protective barrier around bone and joints. Because there is not a lot of soft tissue over the tip of your elbow this puts it at higher risk for potential wound complications if surgery is performed. Thus special precautions are warranted immediately after getting an elbow replacement to encourage good wound healing
You can’t treat an elbow replacement like your original elbow
While every joint replacement comes with some restrictions after the operation, restrictions for elbow replacements are probably a bit more onerous.
In general joint replacements are made from metal and plastic. Over time these parts wear. Heavy use leads to faster wear.
Most surgeons will recommend that patients with an elbow replacement lift no more than 5 lbs at a time with the affected arm or more than 2 lbs continuously. These guidelines come from the Mayo clinic surgeons. They have some of the greatest experience with elbow replacement in the world.
Will the elbow suddenly break if you lift more than this? Likely not. But over time it can wear out more rapidly.
I once saw a patient who had an elbow replacement put in by another surgeon about 8 years prior to his visit with me. The metal components were firmly secured into the bones of the arm. However his bearing surface, which is made of plastic, was completely worn out. Upon further questioning, the patient indicated that he was a farmer and routinely lifted buckets in excess of 30 lbs. And, oh yeah he had already had the bearing replaced once before!
Needless to say, elbow replacements aren’t made for heavy use. Maybe someday in the future they will stand up to more of a beating but we are not there yet.
Elbow replacements are sometimes used to treat fractures
In very select patients, elbow replacements may be a good option for treating very severe fractures of the end of the humerus (upper arm bone). Sometimes in older adults their bone is so weak and their joint surface is crushed so badly that “fixing” the fracture with plates and screws is impossible.
In this case an elbow replacement may be a better option.
This scenario is best reserved for older patients who use their elbow less than younger more active patients. Ideally, if you have a joint replacement, you want it to outlive you. So this option is not for everyone.
If you are considering elbow replacement and would like a personal consultation to learn more about whether this is a good option for you please contact us.