Just before operation patient will be taken from the admission ward to the operating theatre. If patient is feeling worried, patient may be given a sedative medication (a pre-med) while he is in the ward, which will make patient feel a little drowsy.
Patient then be given an anaesthetic. This may be either a general anaesthetic or a local anaesthetic:
- A general anaesthetic will affect patient whole body and make him lose consciousness or put him 'to sleep'.
- A local anaesthetic doesn't put patient to sleep but stops his feeling anything in the affected area. It's usually given by an injection into the base of patient's neck or in the armpit. Some anaesthetists use an ultrasound scan to help guide the needle to the right spot. Patient can take a book or some music along to help his relax during the operation, but patient may also be sedated if need be.
To reach the elbow joint, surgeon will make an incision (cut), usually at the back of the elbow. After making the incision, surgeon will gently move muscles aside to get access to the bone. After removing scar tissue and spurs around the joint, surgeon will prepare the humerus to fit the metallic piece that will replace that side of the joint. The same preparation is done for the ulna.
The replacement stems are placed into the humerus and ulna bones, and kept in place with a bone cement. The two stems are connected by a hinge pin. After the wound is closed, a padded dressing is then placed to protect the incision while it heals.
Some surgeons will place a temporary tube in the joint to drain the surgical fluid. This tube can be easily removed in hospital room within the first few days after surgery.
Implants
The metal replacement parts are made of chrome-cobalt alloy or titanium and there is a liner made of polyethylene (plastic). The bone cement is made of polymethylmethacrylate (acrylic, a type of plastic).
After the operation
The operations usually take around an hour and a half. Giving the anaesthetic takes about half an hour, and recovery before going back to the ward takes another half an hour to an hour.
Patient is taken to a recovery room or high-care unit until he is fully awake and the doctors feel that general condition is stable. Then patient be taken back to the ward.
Sometimes the local anaesthetic from the operation wears off in the middle of the night. This can cause disturbed sleep and tiredness. Patient will probably be given painkillers before he go to sleep to make sure he will be more comfortable. The drip and any drains are usually removed within 24 hours. After that patient will able to start gently moving his arm again.
Patient usually is in hospital for 2–3 nights after his surgery. During this time medical, nursing, physiotherapy and occupational therapy staff will be involved in patient's care. Patient will give drugs after the operation to keep his arm as free from pain as possible. These may include:
- local anaesthetic
- 'patient-controlled analgesia' (PCA) – a system where patient can control his own supply of painkiller going into a vein by pressing a button
- Painkilling injections or tablets.
X-rays of patient new joint will be taken during his stay in the hospital. Patient's arm will be in a sling or splint to protect it. If a tube was placed in the wound during the operation to allow blood to drain out, it's normally removed after 1–2 days (this isn't painful and is usually done on the ward).
It's important during the first few days after surgery that patient keep his hand and forearm raised and exercise his fingers on a regular basis. These exercises are simple to do and include making a full fist and stretching fingers.
After an elbow replacement, some surgeons use a plaster support (called a slab) behind the elbow to keep it in a fairly straight position for a few days. Patient won't be able to move his elbow in the slab, but once its removed patient can start moving his elbow again.
Complications
As with any operation, a very small number of people may have problems after an elbow joint replacement. Most of these problems are quite minor and can be treated easily. The main problems include:
- Infection
- Stiffness
- Pain
- Loosening of the replacement parts
- Fracture of the bone during or after surgery
- Poor healing of the wound
- Wound haematoma (bleeding)
- Damage to nearby nerves causing temporary or, rarely, permanent loss of function.
Orthopaedic surgeon will discuss the risks with patient in detail before he decides to have the operation.
In most cases, infections can be cleared up with tablets or injections of antibiotics. For a more serious infection patient may need another operation to treat the infection and replace the components.
Long-Term Outcomes
The majority of patients have experienced an improved quality of life after elbow replacement surgery. They experience less pain, improved motion and strength, and better function.
Patient should expect to do all basic activities of daily living, such as getting a plate out of a cabinet, cooking dinner, lifting a milk jug, styling his hair, basic hygiene, and dressing. Talk to doctor about activities patient may want to avoid, such as contact sports and activities with a major risk of falling (such as horseback riding or climbing ladders), as well as heavy lifting. These things increase the risk of the metal parts loosening or breaking, or the bone breaking.
When traveling on airplanes, be prepared for extra security screening. There is a chance that metal implant will set off the metal detector during the security check-in.