The elbow is a hinged joint that connects three bones: the upper arm bone (humerus) and the two lower arm bones (the radius and ulna). The humerus and ulna are used for bending and the humerus and radius for rotational movement.

In a healthy joint, the surfaces at the ends of the bones are covered with a tough layer of tissue, called cartilage. This cartilage protects the bones during movement of the elbow. If the cartilage is damaged (through injury) or starts to wear away (as with arthritis), the bones may rub against one another during movement, causing pain and loss of motion in the joint.

Elbow Replacement

When elbow joint pain is severe or patients have a significant loss of motion, doctors may recommend replacement surgery. Replacement may also be needed when the elbow is severely damaged from trauma. Elbow joint replacements are much less common than hip and knee replacements. Douglas P. Hanel, M.D., an Orthopaedic Surgeon with Harborview Medical Center, says because the joint is so small, the surgery can be tricky. Doctors need to be careful to avoid damaging nerves and other important structures in the area.

There are several different kinds of artificial elbow joints. Generally, they consist of a hinge and stems made of metal and plastic. One stem is inserted into the lower end of the humerus. The other end is inserted into the upper end of the ulna. Each of the stems is cemented in place. The hinge connects the two parts. Patients can generally start to move the arm within a few days of surgery. Physical therapy is needed for a few months to regain strength and motion in the arm.

Hanel says the best candidate for elbow replacement is someone who is healthy, about 65 and has a worn-out joint. He warns that although the new joint can relieve pain and restore motion, it can't endure a lot of stress and strain. Thus patients have some important restrictions. They can't use the affected arm to lift more than about 5 pounds (roughly the weight of a gallon jug of milk). He also recommends patients avoid contact sports and activities that require repetitive or continual use of the affected arm, like golfing, tennis or using a hammer.

Over time, the parts in an artificial elbow joint are likely to begin to wear, leading to pain and a need for more surgery. Hanel says most patients will need to have at least one component replaced after ten years.

For general information on joint replacement surgery: American Academy of Orthopaedic Surgeons, public information