I'm investigating the possibility of having an elbow replacement. I am very active and it is my dominant arm. The information I've read so far says there is a high revision rate in people my age (32 years old). Why is that?
The usual reasons patients have an elbow replacement are severe osteoarthritis, nonunion of bone fracture at the elbow, or severe joint instability. Elbow replacements are available for younger adults (less than 40 years old) but usually only as a salvage procedure (in other words, to save the joint). Other nonreplacement options are usually recommended first.
Before replacing the elbow, they suggest trying a synovectomy or interposition arthroplasty whenever possible. Synovectomy is the partial removal of the synovial membrane that lines the non-cartilaginous surfaces within joints like the elbow. Usually the head of the radius (top of the forearm bone at the elbow) is removed at the same time.
Interpositional arthroplasty is the removal of the damaged joint and placement of a rolled up tendon (or other soft tissue) in the empty joint space. The main goal of interposition surgery is to ease pain where the surfaces of the elbow joint are rubbing together. The piece of tendon forms a "spacer" that separates the surfaces of the joint. This procedure is not recommended if the patient has significant bone loss, gross joint instability, or a severe elbow deformity.
Elbow replacement has been around for many years but the success rates have not always been acceptable. This is improving over time with better surgical techniques and better implants.
Studies show that complications following elbow replacement in younger adults that require revision surgery include deep infection, implant loosening, triceps weakness, and implant wear.
Patients with posttraumatic arthritis who need this type of surgery are more likely to develop problems leading to a second surgery. They have a much higher complication rate than patients with rheumatoid arthritis.
Even with the high complication and revision rates, there is still a place for elbow replacement in younger patients. Those with advanced arthritic disease who have already failed nonreplacement options may still be aided by a joint replacement. It is certainly preferred over an elbow fusion since the fusion eliminates elbow motion and creates a functionally disabling condition
Andrea Celli, MD, and Bernard F. Morrey, MD. Total Elbow Arthroplasty in Patients Forty Years of Age or Less. In The Journal of Bone and Joint Surgery. June 2009. Vol. 91A. No. 6. Pp. 1414-1418.
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