Total Elbow Arthroplasty

Total elbow arthroplasty (TEA) is a surgical procedure that involves replacing the damaged or arthritic joint surfaces of the elbow with artificial components. The goal of TEA is to alleviate pain, restore function, and improve mobility in patients with severe elbow arthritis or other conditions that affect the elbow joint.

Indications

TEA is typically indicated for patients with:

• Severe rheumatoid arthritis or other inflammatory arthropathies
• Osteoarthritis (wear and tear arthritis)
• Post-traumatic arthritis (arthritis resulting from a previous injury)
• Avascular necrosis (death of bone tissue due to lack of blood supply)
• Nonunion or malunion of elbow fractures

Surgical Procedure

The TEA procedure typically involves the following steps:

1. A general or regional anesthetic is administered to ensure patient comfort during the procedure.
2. An incision is made in the back of the elbow to access the joint.
3. The damaged or arthritic joint surfaces are removed, and the humerus (upper arm bone) and ulna (forearm bone) are prepared for the implantation of artificial components.
4. A metal and plastic hinge is implanted, which consists of a humeral component, an ulnar component, and a radial head component.
5. The artificial components are secured to the surrounding bone using cement or other fixation methods.
6. The incision is closed, and the elbow is immobilized in a splint or cast to allow for healing.

Types of Implants

There are several types of implants used in TEA, including:

• Linked implants: These have a hinge that connects the humeral and ulnar components, allowing for flexion and extension.
• Unlinked implants: These do not have a hinge and rely on soft tissue stability for joint movement.
• Convertible implants: These can be converted from an unlinked to a linked implant if necessary.

Postoperative Care and Rehabilitation

After TEA, patients typically require:

• Pain management with medication and other modalities
• Immobilization in a splint or cast for several weeks to allow for healing
• Physical therapy to regain range of motion, strength, and function
• Follow-up appointments with the surgeon to monitor progress and remove sutures or staples

Risks and Complications

As with any surgical procedure, TEA carries risks and potential complications, including:

• Infection
• Nerve damage
• Blood clots
• Implant loosening or failure
• Heterotopic ossification (abnormal bone growth)

Outcomes and Expectations

The outcome of TEA can vary depending on individual factors, such as the underlying condition, overall health, and adherence to postoperative rehabilitation. Generally, patients can expect:

• Significant pain relief
• Improved range of motion and function
• Enhanced quality of life
• A return to daily activities and hobbies, although heavy lifting or repetitive stress may be limited