What is Total Elbow Replacement?
Total Elbow Replacement (TER) is a joint-replacement operation that removes the worn or damaged parts of the elbow and replaces them with a metal–plastic hinge. The new joint aims to alleviate pain, enhance mobility, and enable people to return to daily tasks such as eating, dressing, and gentle gardening.
When is TEA considered?
TEA is reserved for elbows that remain painful and stiff despite taking tablets, receiving injections, wearing splints, and undergoing physiotherapy.
The common indications are:
- Rheumatoid arthritis — end-stage joint destruction in patients with low functional demands.
- Post-traumatic arthritis — chronic pain after badly healed fractures or dislocations.
- Primary osteoarthritis — severe degenerative change, usually in adults over 65, often manual workers.
- Complex distal humerus fractures — shattered elbow in elderly people with fragile bone.
- Chronic instability or non-union — ligaments or bone fail to hold the joint together.
- Revision after tumour excision or failed previous elbow surgery.
Certain conditions rule out TEA: active infection, Charcot (neuropathic) joint and high-impact sporting expectations.
Implant designs – linked, unlinked or convertible
|
Design |
How it works |
Best for |
Key caution |
|
Linked / semiconstrained |
Humeral and ulnar stems are joined by a “sloppy hinge” that allows a few degrees of give. |
Poor bone stock, weak ligaments, severe deformity. |
Extra stresses can speed up plastic wear and loosening. |
|
Unlinked / uncoupled |
Two separate stems rely on intact ligaments for stability. |
Good bone and soft-tissue envelope. |
Higher dislocation risk if ligaments are stretched or torn. |
|
Convertible |
Can be implanted unlinked and converted to linked during surgery if instability is detected. |
Fractures or borderline ligament competence. |
Long-term survival data still emerging. |
The operation in brief
- Anaesthetic — general or regional.
- Surgical approach — usually from the back of the elbow; modern techniques try to spare the triceps tendon.
- Bone preparation — diseased surfaces are trimmed and canals broached.
- Component fixation — stems cemented into humerus and ulna; hinge pin inserted if linked.
- Wound closure & dressings — ulnar nerve protected or moved if tight.
Operating time is typically 90–120 minutes.
Recovery roadmap
- Hospital stay: 1–2 days.
- Early movement: Fingers, wrist and gentle elbow bends start in the first week.
- Physiotherapy: Structured programme begins once the wound has healed (about 2 weeks).
- Weight limits: Lift no more than 5–10 lb (2–5 kg) for life to protect the implant.
- Driving: Usually safe after 6–8 weeks when comfortable control of the wheel is regained.
Benefits and expected outcomes
- Reliable pain relief in over 9 out of 10 patients.
- Flexion–extension arc commonly improves to 100–130 degrees.
- High satisfaction scores, especially in rheumatoid arthritis.
- Ten-year implant survival around 90 % for inflammatory disease, 80 – 85 % for primary osteoarthritis, and 70 % for post-traumatic cases.
Possible risks to weigh up
|
Short-term (first 3 months) |
Long-term |
|
Infection (1 – 12 %) |
Aseptic loosening (5 – 10 %) |
|
Wound-healing problems |
Periprosthetic fracture |
|
Temporary ulnar-nerve numbness |
Plastic bearing wear & osteolysis |
|
Triceps weakness |
Chronic infection |
Prompt recognition and expert care greatly improve outcomes if complications arise.
Clinical Pearls / Key Points
- Linked implants provide rescue stability but load the bone–cement interface more heavily.
- Protect the ulnar nerve early; tingling in the ring and little fingers after surgery is common but usually settles.
- Strict lifelong weight limits are non-negotiable and key to avoiding revision surgery.
- Triceps-sparing approaches reduce extension weakness and speed rehabilitation.
- Two-stage revision with an antibiotic spacer remains the gold standard for deep infection.
Patient FAQs
Will I be pain-free straight after surgery?
Most pain linked to arthritis disappears quickly, but surgical soreness can last a few weeks. Properly timed pain relief and early gentle movement help.
Can I play golf or tennis afterwards?
Low-impact putting or chipping is usually fine. Powerful swings or racquet sports risk loosening the implant and are discouraged.
What happens if the replacement wears out?
A revision is possible but technically demanding. Following lifting rules and attending yearly reviews reduce the chance of further surgery.
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If you have elbow pain when throwing, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.ukDisclaimer
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