Elbow arthroplasty (replacement surgery) is an effective option for people with debilitating elbow pain that doesn’t go away with other treatments. But complication rates are higher than with other joint replacement surgeries.

Elbow arthroplasty is the replacement of all or part of your elbow joint with artificial components. This procedure can help reduce pain and improve movement.

Depending on your specific symptoms, a doctor may recommend either a total replacement or a partial replacement, also known as hemiarthroplasty.

In a total replacement, the artificial joint is in two pieces that may or may not be linked.

Elbow replacement isn’t as common as other types of arthroplasty, such as hip or knee. It also tends to have a higher complication rate. Still, most people report good results.

A doctor might recommend elbow arthroplasty if you have severe pain in your elbow joint from any of the following conditions:

According to the Arthritis Foundation, doctors rarely recommend total elbow arthroplasty (TEA) for people under the age of 60. The elbow implants can wear out after a few years. Candidates are usually older adults who may be less active or experiencing end stage inflammatory arthritis or osteoarthritis.

A 2022 review notes that elbow replacement may not be the best option for active people under the age of 65 or people who previously had surgery to remove parts of their elbow bone.

Elbow arthroplasty procedures may be partial or total, or use linked or unlinked components.

Total vs. partial elbow arthroplasty

In a TEA, doctors remove all parts of your elbow joint and replace them with artificial components. This involves removing the damaged parts of the upper arm bone (humerus) and one of the forearm bones (ulna). A surgeon places a metal stem inside each of what’s left of these bones.

In partial elbow arthroplasty, doctors remove only part of the elbow joint. An example is distal humerus arthroplasty, where a surgeon removes the lower part of your upper arm bone at the elbow joint and puts a metal piece in its place.

Linked vs. unlinked elbow replacements

A linked elbow replacement uses a hinge pin to connect the replacement parts.

Unlinked elbow replacements don’t have a hinge. Instead, your ligaments hold the replacement pieces together. You can only have an unlinked elbow replacement if you don’t have ligament damage.

Research suggests that both types are equally effective. Some researchers believe unlinked replacements may be a better option for many younger people.

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Illustrated by Jason Hoffman

Before surgery, a doctor may order blood work. They may also take new images of your elbow with an X-ray or CT scan.

Your medical team may be in touch in the days before surgery to tell you how to prepare for surgery. You may have to change current medications or fast before the operation.

On the day of surgery, you’ll likely meet with an anesthesiologist, since you’ll probably be under general anesthesia.

During surgery, you’ll lay on your back or side. The surgeon will:

  1. Prop up your elbow, so it’s bent at a 90-degree angle.
  2. Make an incision at the back of your elbow.
  3. Move the muscles aside.
  4. Remove the scar tissue around the joint.
  5. Prepare the humerus and ulna for the artificial joint.
  6. Place the artificial joint stems inside the humerus and ulna.
  7. Apply bone cement to keep the stems in place.
  8. Connect the stems with a hinge pin (if linked).
  9. Close the incision and protect the area with a padded surgical dressing. They may also include a surgical tube for fluid drainage.

Side effects from elbow arthroplasty are more common than in hip or knee replacements. A 2020 review of studies of people with RA who undergo elbow replacement found that about 1 in 6 implants fail, and 1 in 4 people experience complications.

Possible complications of TEA include:

  • Periprosthetic joint infection: An infection occurs at the site of the new joint in about 1% to 12.5% of TEAs.
  • Aseptic loosening: The replacement joint fails not due to an infection or mechanical reason but due to causes like bone reabsorption. This is more likely in unlinked replacements.
  • Periprosthetic fracture: A fracture occurs at the site of the bones of the new joint. This outcome is challenging to correct surgically.
  • Triceps insufficiency: In less than 1 in 40 people who undergo TEA, the tricep muscles weaken or rupture.
  • Bushing wear: This is wear in the mechanical parts of the replacement joint.
  • Lesions of the ulnar nerve: There might be damage to the ulnar nerve, which runs down your arm to your fingers.
  • Wound breakage: The surgical wound opens.

If you experience a complication, you may need another procedure to correct the problem. This is called revision arthroplasty.

You’ll likely stay in the hospital for a few days after elbow arthroplasty. While in the hospital and during recovery at home, your care might include pain medication and rehabilitation exercises.

You may not be able to use your elbow without support for 6 weeks after surgery. This includes putting weight on the arm or pushing with resistance.

Even after the recovery period, you may have some permanent restrictions. These include never lifting anything heavier than 5 to 10 pounds (2.25 to 4.5 kilograms).

You may also have to avoid contact sports or activities with a high risk of falling. These activities may increase the risk of damaging the replacement elbow joint.

Here are some frequently asked questions about elbow arthroplasty.

What is the success rate for elbow arthroplasty?

TEA reduces pain and improves motion and function for most people. More than 85% of people with RA who undergo TEA report positive outcomes.

How long does an elbow replacement last?

Although there’s a risk of wear with elbow implants, research shows that most last over a decade. A 2022 review found that 92% of linked replacements and 84% of unlinked replacements lasted more than 10 years.

What are elbow replacements made out of?

The metal replacement parts are made of titanium or a chrome-cobalt alloy. They also contain a liner made of plastic. Bone cement, which helps hold the replacement parts in place, is made of acrylic.

How much does elbow arthroplasty cost?

A 2016 study based on data from 2007 to 2011 found the average hospital cost of TEA was $12,300 to $20,300. That cost included hospital stay, which was an average of 4.2 days in the study.

What you pay out of pocket will be based on what your insurance or Medicare covers. According to Medicare.gov, the average cost to the patient is $1,852 to $2,815, depending on where you have the procedure.

A partial elbow replacement may cost slightly less. But a revision surgery may cost more due to a longer operating time and more care needed both before and after surgery.

Elbow arthroplasty can usually help reduce pain and improve range of motion in people with serious elbow pain due to advanced arthritis, severe fractures, or elbow instability. Although side effects are more common in this procedure than in other joint replacement surgeries, most people report positive outcomes. Most replacements last for at least 10 years.

You can undergo either a partial or total replacement. There are also linked and unlinked model types. A doctor can help you determine the best procedure and model for you.