Our Summary

This research paper discusses a surgical procedure called total elbow arthroplasty (TEA), or elbow replacement, and the complications that can arise from it. Compared to hip and knee replacements, elbow replacements have a higher rate of problems and don’t last as long. Issues most commonly occur due to the implant becoming loose, infections, and fractures around the implant.

The paper reviews how to deal with a failed elbow replacement. This includes evaluating the patient before surgery, the different surgical methods available, how to revise the procedure, and the outcomes and complications that can occur following the revamp of the elbow replacement. This can include handling soft tissues, possible need for flap coverage, managing the triceps muscle, preserving bone, and dealing with simultaneous infection or fracture.

FAQs

  1. What are the most common reasons for revising modern total elbow arthroplasty (TEA) implants?
  2. What are some of the key considerations and challenges in revision total elbow arthroplasty?
  3. How does the complication rate and survivorship of total elbow arthroplasty compare with hip and knee arthroplasty?

Doctor’s Tip

A doctor might advise a patient undergoing elbow surgery to follow their post-operative care instructions closely, including keeping the elbow elevated and performing prescribed exercises to aid in recovery and prevent complications. It is also important for the patient to attend all follow-up appointments and communicate any concerns or changes in symptoms to their healthcare provider promptly. Following a healthy lifestyle, including maintaining a balanced diet and avoiding smoking, can also help promote healing and reduce the risk of complications.

Suitable For

Patients who may be recommended for elbow surgery include those with severe arthritis, fractures, instability, or failed previous elbow arthroplasty. Revision total elbow arthroplasty may be recommended for patients who have experienced complications such as implant loosening, infection, or periprosthetic fracture. Additionally, patients with significant pain, limited range of motion, and functional impairment may also be candidates for elbow surgery.

Timeline

Before elbow surgery:

  1. Patient experiences chronic pain, stiffness, and limited range of motion in the elbow joint.
  2. Patient undergoes a thorough evaluation by a surgeon to determine the need for surgery.
  3. Preoperative tests and imaging studies are conducted to assess the extent of damage to the elbow joint.
  4. The surgeon discusses the risks and benefits of the surgery with the patient and obtains informed consent.
  5. Patient may undergo physical therapy and prehabilitation to improve strength and flexibility in the elbow joint before surgery.

After elbow surgery:

  1. Patient undergoes the surgical procedure, which may involve total elbow arthroplasty or revision surgery.
  2. Patient is monitored closely in the hospital for complications such as infection or excessive bleeding.
  3. Patient begins a rehabilitation program to regain strength and range of motion in the elbow joint.
  4. Follow-up appointments with the surgeon are scheduled to monitor the healing process and assess the success of the surgery.
  5. Patient may experience temporary pain and swelling in the operated elbow, which gradually improves with time.
  6. Full recovery from elbow surgery may take several months, during which the patient continues with physical therapy and follows the surgeon’s instructions for postoperative care.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with elbow surgery?
  2. What is the expected recovery time and rehabilitation process following elbow surgery?
  3. Will I need physical therapy after surgery, and for how long?
  4. What type of implant will be used for the surgery, and how long can I expect it to last?
  5. What are the chances of needing revision surgery in the future?
  6. What is the success rate for revision total elbow arthroplasty?
  7. How will my pain be managed during and after the surgery?
  8. Will I need any special accommodations or assistive devices after surgery?
  9. Are there any restrictions on activities or movements I should be aware of after surgery?
  10. How soon after surgery can I expect to regain full function and range of motion in my elbow?

Reference

Authors: Xiao RC, Model Z, Kim JM, Chen NC. Journal: Hand Clin. 2023 Aug;39(3):341-351. doi: 10.1016/j.hcl.2023.03.001. Epub 2023 May 11. PMID: 37453762