Elbow joint replacement surgery, also known as elbow arthroplasty, is a complicated orthopedic surgery in which the natural elbow joint is replaced with an artificial joint made from two implants attaching to the upper and lower arm bones with a hinge between them (total elbow replacement) or just one piece of prosthesis attaching to the head of one of the arm bones (partial elbow replacement).
Although elbow replacement is much less common than knee or hip replacement, it is just as successful in relieving joint pain and returning people to activities they enjoy.
The following table describes general information about Elbow Replacement Surgery including Elbow Replacement Surgery cost in Iran, recovery time, and to name but a few.
$ 2000- 3500
Back to Work
Duration of Operation
Minimum Stay in Iran
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Before Elbow Replacement Surgery
The elbow is a hinge joint which is made up of three bones:
. The humerus (upper arm bone)
. The ulna (forearm bone on the pinky finger side)
. The radius (forearm bone on the thumb side)
The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.
Muscles, ligaments, and tendons hold the elbow joint together.
Why it's done
Several conditions can cause elbow pain and disability, and lead patients and their doctors to consider elbow replacement surgery.
. Rheumatoid Arthritis
This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."
. Osteoarthritis (Degenerative Joint Disease)
Osteoarthritis is an age-related, "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the elbow softens and wears away. The bones then rub against one another. Over time, the elbow joint becomes stiff and painful.
. Post-traumatic Arthritis
This type of arthritis can follow a serious elbow injury. Fractures of the bones that make up the elbow, or tears of the surrounding tendons and ligaments may cause damage to the articular cartilage over time. This causes pain and limits elbow function.
. Severe Fractures
A severe fracture of one or more bones that make up the elbow is another common reason people have elbow replacements. If the elbow is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this type of case, a surgeon may recommend an elbow replacement. Older patients with osteoporosis (fragile bone) are most at risk for severe elbow fractures.
In addition, some fractures do not heal well and may require an elbow replacement to address continuing problems.
Instability occurs when the ligaments that hold the elbow joint together are damaged and do not work well. The elbow is prone to dislocation. Chronic instability is most often caused by an injury.
Who are good candidates for elbow replacement surgery?
If you have rheumatoid arthritis, osteoarthritis, chronic instability, or have suffered severe, complex fracturing and your elbow pain is interfering with your daily life, while active or while at rest, you may be a good candidate for elbow replacement surgery. If you have post-traumatic arthritis due to an injury, you may also benefit from elbow replacement surgery.
In general, elbow replacement procedures work best for older patients who live more sedentary lifestyles.
However, designs and technology for elbow arthroplasty and artificial components are evolving rapidly. New designs may work better for younger patients who want to lead active lives post-surgery.
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. Medical Evaluation
If you decide to have elbow replacement surgery, your orthopedic surgeon may ask you to schedule a complete physical examination with your family physician several weeks before surgery. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process.
Many patients with chronic medical conditions, like heart disease, must also be evaluated by a specialist, such a cardiologist, before the surgery.
Be sure to talk to your orthopedic surgeon about the medications you take. Some medications may need to be stopped before surgery. For example, the following over-the-counter medicines may cause excessive bleeding and should be stopped 2 weeks before surgery:
. Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, and naproxen sodium
. Most arthritis medications
If you take blood thinners, either your primary care doctor or cardiologist will advise you about stopping these medications before surgery.
. Home Planning
Making simple changes in your home before surgery can make your recovery period easier.
For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves.
When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. If you will not have any support at home immediately after surgery, you may need a short stay in a rehabilitation facility until you become more independent.
. Before Your Operation
You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be taken to the preoperative preparation area and will meet a doctor from the anesthesia department.
You, your anesthesiologist, and your surgeon will discuss the type of anesthesia to be used. In most total elbow replacement surgeries, a general anesthetic that puts you to sleep for the entire operation is used.
Also let your doctor know if you drink alcohol and if you smoke, you should stop before your surgery.
Benefits of an Elbow Replacement
The operation replaces the damaged joint surfaces with a synthetic joint (commonly made of metal and plastic). The aim of elbow replacement surgery is to give you a pain free, mobile elbow that enables you to perform normal everyday activities. It is recommended that after this surgery the arm is not used to carry heavy objects or for heavy manual activities, as these may lead to early failure of the replacement.
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What are the Risks and Complications of Elbow Replacement Surgery?
The most common risks and complications are as follows:
. Implant Problems
. Injury to nerves and blood vessels
. Allergic reaction to the artificial joint
. Broken bone
. Stiffness or instability of the joint
. Loosening or wearing of the artificial parts
. Weakness or failure in the tendons of your arm
. Wound Healing Problems
. Heart attack
There are risks because of the anesthesia, such as an allergic reaction to those medicines and breathing problems. As with any surgery, bleeding and blood clots are possible, too.
Types of elbow replacement
In terms of the extensiveness of the surgery, an elbow replacement can be partial or total.
. Partial elbow replacement
A partial elbow arthroplasty is a treatment option for elbow joint damages, in which only one part of the joint is replaced with an orthopedic prosthesis. This elbow surgery is technically called Hemiarthroplasty.
. Total elbow replacement
A total elbow arthroplasty involves replacing all parts of the elbow joint with prostheses. In this procedure, the cartilage of the ends of the three arm bones (the distal end of the humerus in the upper arm and the proximal ends of the ulna and radius in the forearm) is removed and replaced with prosthetic components that together function similar to your natural elbow joint.
Types of elbow prostheses
There are two main types of prosthetic devices available:
. Linked. This type of prosthesis acts somewhat like a loose hinge because all the parts of the replacement joint are connected. This provides good joint stability, but the stresses of movement can sometimes result in the prosthesis working itself loose from where it's inserted into the arm bones.
. Unlinked. This type of device comes in two separate pieces that aren't connected to each other. This design depends on the surrounding ligaments to help hold the joint together, which can make it more prone to dislocation.
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How is an elbow replacement performed?
Elbow replacement surgery takes about 2 hours. You'll get general anesthesia, so you won’t be “awake” for it. You’ll need to stay in the hospital for up to 4 days.
To reach the elbow joint, your surgeon will make an incision (cut), usually at the back of the elbow. After making the incision, your surgeon will gently move muscles aside to get access to the bone. After removing scar tissue and spurs around the joint, your 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 your hospital room within the first few days after surgery.
Alternatives to surgery
The decision to proceed with an operation is an individual choice between every patient and their Surgeon. You will only be offered an operation if your surgeon believes that this will help improve your symptoms. Very few operations are essential and all have a degree of risk. Some patients can learn to manage their symptoms with painkillers, and improve their function with muscle strengthening and physiotherapy.
After Elbow Replacement Surgery
After the operation, you’ll have stitches and a bandage on your new elbow. You may also need to keep your arm in a splint to keep it stable while it heals.
Because elbow replacement involves cutting skin, tendons, and bone, you'll need strong pain medications after surgery. You'll also take pain meds for 1 to 2 weeks after you go home from the hospital.
It will take time to get used to your new elbow. For instance, you won't be able to lift anything heavier than a cup of coffee for 6 weeks after surgery. It’s a good idea to line up help ahead of time.
You'll learn simple exercises and other types of physical therapy to help your arm get stronger and move better. You’ll do “range of motion” exercises, such as bending and straightening your arm.
Elbow replacement usually reduces pain and helps your elbow work better. But it may not make the joint as good as it was before disease or injury hurt it.
You’ll need to avoid activities that can cause further injury, such as hammering, playing contact sports, and lifting heavy weights. With good care, your new elbow should serve you well for many years.
Your medical team will give you several doses of antibiotics to prevent infection. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely stay at the hospital 2 to 4 days after your surgery.
After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.
Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
A careful, well-planned rehabilitation program is critical to the success of an elbow replacement. You will be taught some exercises for your hand and wrist to avoid stiffness and help to control swelling. You will do gentle elbow range-of-motion exercises as the incision heals. Your doctor may prescribe therapy or may teach you how to do the exercises yourself.
You will most likely not be allowed to put any weight on your arm or push against resistance with your hand until about 6 weeks after your surgery.
Function following an elbow replacement
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.
An elbow replacement is unlikely to last forever. The more it is used, the faster it is likely to wear out. You should be aware that elbow replacement surgery is carried out to reduce pain, not provide strength. However, it is likely that a reduction in pain will improve your function.
You should only use your arm with an elbow replacement for ‘light’ activities. You should avoid lifting objects with your elbow replacement arm, and avoid repetitive activities (even with less weight) should be avoided. You should also avoid activities where you hold an object to carry out a task, for example a hammer, golf club, racquet, or spade. These activities may reduce the lifespan of your joint replacement.
Activities such as washing, dressing, cooking, light gardening, and light domestic chores are ok to do if they are not repetitive and do not continue for prolonged periods of time.
Lifting light objects such as clothing, a cup, or meal preparation is fine.
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What do I do about the wound?
Your wound will most likely have a shower-proof dressing on when you are discharged.
You will be given extra dressings to take home with you. You may shower or wash with the dressing in place, but do not run the shower directly over the operated elbow, or soak it in the bath. Pat the area dry and do not rub.
Sometimes you will be discharged with bandages around your arm, or with a non-shower proof dressing. If this is the case you will not be able to shower until they are removed.
You may have dissolvable stitches and sticky dressings called Steristrips. If not, the stitches/ clips will need to be removed at your GP practice or at your hospital follow up appointment. The nursing staff will advise you when this can happen; it is usually between
10–14 days after your operation. Avoid using spray deodorant, talcum powder or perfumes on or near the wound until it is fully healed.
Do I need to do exercises?
Yes. You will be shown exercises by the Physiotherapist. You will start exercises to move the elbow on the first day after the operation. You will then need to continue with exercises when you go home. Outpatient physiotherapy appointments will be organised for you.
The exercises aim to stop your elbow getting stiff, and to strengthen your muscles. They will be changed as you progress, and made specific to your elbow and your lifestyle.
You will need to get into the habit of doing regular daily exercises at home for several months. They will enable you to gain maximum benefit from your operation.
Elbow Replacement Surgery Cost
The cost of an Elbow Replacement Surgery in Iran is between $ 2000-3500 and depends on the type of surgery (Total or Partial) and the geographical location.