A reliable solution for complex elbow breaks in older adults
What is elbow arthroplasty for fractures?
Elbow arthroplasty replaces a shattered distal humerus (the lower arm bone) with a tailored prosthesis when traditional fixation (plates and screws) is unlikely to succeed. It includes Total Elbow Arthroplasty (TEA)—a linked hinge implant—and Distal Humeral Hemiarthroplasty (DHH)—a unlinked cap-and-stem design. Both restore comfort, movement and independence in carefully selected patients with severe comminution or poor bone quality.
Why choose arthroplasty over ORIF?
Older bones with multiple fragments, osteoporosis or failed prior surgery often cannot hold metalwork securely. Arthroplasty:
- Bypasses bone healing—immediate joint function
- Avoids non-union or metal failure seen in up to 44 % of ORIF cases in over-65s
- Improves quality of life when ORIF is impractical
Implant types
Total Elbow Arthroplasty (TEA)
- Linked, semi-constrained hinge
- Stable even with weak ligaments
- Lifelong lifting limit of 5 kg
- Risks: stem loosening, polyethylene wear, periprosthetic fracture
Distal Humeral Hemiarthroplasty (DHH)
- Unlinked cap-and-stem
- Preserves ulna bone and natural cartilage
- Fewer activity limits
- Requires robust ligament repair to prevent instability
Who benefits most?
- Patients over 65 with comminuted distal humerus fractures
- Severe osteoporosis where plating will fail
- Previous ORIF complications (non-union, hardware breakage)
- Low-demand lifestyle willing to follow weight restrictions
Surgical steps in brief
- Preoperative planning: CT scans to assess fracture pattern and implant sizing.
- Approach: Posterior incision with triceps-sparing technique to allow early movement and protect the ulnar nerve.
- Bone preparation: Remove fragments, broach canals for humeral (and ulnar, in TEA) stems.
- Implantation: Cemented insertion of chrome-cobalt or titanium stems; hinge pin for TEA; ligament repair for DHH.
- Closure: Layered repair, drain as needed, soft-tissue coverage to minimise infection risk.
Recovery and rehabilitation
- Days 1–7: Elevation, finger and wrist exercises. Semi-extension splint if soft tissues are fragile.
- Weeks 2–6: Begin guided physiotherapy, focusing on gentle flexion/extension.
- After 6 weeks: Gradual return to light activities. Avoid single lifts over 5 kg (TEA) or repeated lifts over 1 kg.
- Long term: Daily tasks restored; avoid gardening spades or heavy groceries to protect implant.
Clinical Pearls / Key Points
- Linked TEA implants ensure stability but require strict weight limits to prevent early wear.
- DHH spares the ulna component—ideal when collateral ligaments can be reliably repaired.
- Triceps-sparing approaches reduce extension weakness and speed up rehabilitation.
- Ulnar-nerve symptoms occur in up to 5 %—early detection and release improve outcomes.
- TEA survival is 94 % at five years, 75 % at ten; aseptic loosening is the main long-term failure mode.
Patient FAQs
Will I regain full use of my arm?
Most patients achieve a functional range of motion (0–120°) for daily tasks like feeding and dressing, though high-force activities remain restricted.
How soon can I wash and dress myself?
You’ll begin gentle elbow bends within 1 week; basic self-care is usually possible by 4–6 weeks under physiotherapy guidance.
What if the implant wears out?
Revision is technically demanding but possible. Strict adherence to lifting limits and follow-up reviews minimise that risk.
Call to Action
If you have pain, 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.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025