What's the best way to deal with an elbow replacement that is coming loose? The surgeon says it's not from an infection, so I guess that's good. It will be a week before I can get back in to find out what's next. What can you tell me?
As with any joint replacement procedure, there can be problems or complications. Loosening of the implant is probably the most common post-operative problem. Deep infection (inside the joint) is a major concern and can lead to implant loosening.
Loosening of the implant can occur even when there hasn't been an infection. If it occurs in the absence of an infection, it is referred to as an asceptic loosening. Fracture of the bone around the implant can also cause the implant to give.
It's a complicated problem. Normal elbow function requires slight side-to-side motion with a little rotation even as the joint is bending and straightening. Reproducing all of that with a metal implant is a challenge.
The implant has to be placed in the right position with the correct angle and just the right amount of soft tissue tension. The alignment of the implant stem (placed down into the bone to anchor the implant) is another key feature that can affect elbow function.
The capsule and ligaments around the elbow along with the muscles and their tendon attachments contribute to elbow stability and function. Keeping all of this balanced after removing the diseased elbow and putting an implant in place requires considerable surgical technical expertise.
Once loosening has been diagnosed, the treatment can vary. If you aren't having any painful symptoms, altered motion, or loss of function, then a wait-and-see period of observation may be advised. Rehab to strengthen the muscles on either side of the elbow may be a good idea.
Once your surgeon is able to take a closer look, then an appropriate plan of follow-up care can be determined. If you are having pain and other symptoms, then it may be necessary to perform a second surgery.
The procedure doesn't have to be extreme -- the surgeon may just remove (and replace) the part that is loose. If the joint is unstable, then it may have to be completely taken out and a new implant put back in.
Jaehon M. Kim, MD, et al. Complications of Total Elbow Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. June 2011. Vol. 19. No. 6. Pp. 328-339.
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