Understanding Total Elbow Replacement Protocol

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A total elbow replacement is typically a last resort treatment option for patients whose elbow injuries have not responded to other solutions, or whose injuries are too severe for less invasive procedures to be effective.

To complete an elbow replacement, a surgeon removes the damaged elbow joint and replaces it with an artificial one made from either titanium or chrome-cobalt alloy, restoring the individual’s range of motion and eliminating the source of pain.

Overall, the results of total elbow replacements are exceptionally positive, with serious complications occurring in less than 5 percent of all cases.

What Conditions Lead to Elbow Replacement Surgery?

There are numerous activities, diseases and injuries that can result in a patient requiring an elbow replacement.


Below are some of the most common causes:

  • Rheumatoid Arthritis

Rheumatoid Arthritis is a lifelong medical condition that causes the body’s immune system to erroneously attack the joints, irritating the synovium (the natural lubricant that protects our joints and makes them easier to move) and causing painful inflammation. In severe cases, this can lead to the deterioration of the bones, tissues and cartilage that form the joint, making a total elbow replacement necessary.

  • Tendinitis

Tendinitis is essentially the inflammation or swelling of a tendon (the fibrous tissues that attach our muscles to our bones). In most cases, tendinitis can be treated with less invasive techniques like cortisone shots and physiotherapy, but in rare, extreme cases the body does not respond to these methods and elbow replacement surgery is required.

  • Fractures

When an individual falls and lands on their elbow, or accidentally twists the arm beyond its typical range of motion, a fracture can occur, misplacing and potentially shattering the cartilage and bones of the elbow. In some cases, non-surgical treatment options can repair an elbow fracture, but not always. In instances where the bone has broken through the skin, or where an infection has developed, surgery is more likely to be necessary.

What are the Risks of Elbow Replacement Surgery?

While serious complications from elbow replacement procedures are rare, they are possible. Thus, it is crucial for all patients considering this type of operation to be aware of potential drawbacks.

Some of the most common risks associated with a total elbow replacement are:

  • Infection

The infection rate for full elbow replacement is between 2-5 percent. Infections can occur during the time of surgery, or at any point during the healing process.

Below are some of the leading factors that contribute to a joint replacement infection:

  • Surgical utensils and equipment that have not been adequately sterilized
  • Bacteria entering the body via incisions that have not yet completely healed
  • Contamination of the artificial joint

Individuals with lowered immune systems, like those who have been diagnosed with HIV or diabetes mellitus, are also more likely to develop an infection after surgery since there body’s are not as equipped to fend off contagions and typically take longer to heal.

  • Blood Clotting

While the rate of blood clotting among patients who have had elbow replacement surgery is quite low (0.26 percent of all cases), it is still a concern that should be addressed. Deep vein thrombosis (DVT), a form of blood clotting that has been associated with joint replacement surgery, can cause edema in the arms, pain and erythema. Before making the decision to undergo a total elbow replacement, it is important to discuss blood clotting with your physician so they can address any concerns and provide you with a more personalized account of your susceptibility.

  • Nerve Damage

The elbow has two major nerves that run through it: the ulnar nerve and the radial nerve. During surgery, practitioners must maneuver around these sinews, carefully implanting the artificial joint. If these nerves are touched, pulled, or exposed to heat during the procedure, nerve damage can occur, causing a sensation of tingling or numbness, and sometimes pain in the hand or arm. For many, these sensations go away as the elbow heals, but for a small percentage of patients they never fully dissipate.

Preparing for a Total Elbow Replacement

Surgeons and physicians follow strict elbow replacement protocols that protect the health of their patients and help secure optimal outcomes.

These protocols begin before the patient even enters the operating room, laying the groundwork for a smooth and problem-free surgical experience.

Below is a brief overview of these preemptive protocols and what patients can expect:

3-4 Weeks Prior to Surgery

  • Your doctor will advise you to prepare your home for when you return from the hospital since you will be under strict orders to rest your arm. Recommended preparations include preparing microwavable meals if you live alone, moving frequently-used items to lower cabinets where you don’t have to reach for them, and eliminating any tripping hazards.
  • You will have your final consultation with your physician prior to surgery. This is the time to ask any questions you may have regarding your procedure and recovery.

2 Weeks Prior to Surgery

  • You will be advised by your doctor to avoid any anti-inflammatory medications beyond this point.
  • Your doctor may require you to purchase equipment such as a post-operative brace or a mechanical grabber.

Week of Surgery

  • Compile a detailed list of any medications you take, the dosage, and how frequently you take them. Your surgeon will want to know about any medications before commencing your operation.
  • Pack a bag for the hospital that includes a loose-fitting outfit. You will not be able to wear a tight, long-sleeve shirt while your arm heals. It’s also recommended that you bring shoes with good grip to avoid the likelihood of tripping or falling.

Day of Surgery

  • Your doctor will likely request that you fast (avoid food and liquids other than water) for at least 8 hours before your operation.

Total Elbow Replacement Procedure

Many patients want to have at least a basic understanding of what will occur during their joint replacement surgery.

Below is a brief overview of the elbow replacement process:


Elbow replacements are performed under general anesthetic, which means the patient is asleep and unconscious during the procedure. Typically, the anesthetic is administered by using a combination of inhaled gas and intravenous medications.


Once the patient is asleep, the surgeon will make an incision in the skin on the inside of the arm. This incision will provide access to the joint without disrupting or damaging the muscles and tendons that surround the area.

Bone Preparation and Implanting

After your surgeon has successfully navigated around your muscles and nerves, they will remove some or all of the joint bone (this will depend on if you are having a partial elbow replacement or a full replacement), and make room for the artificial joint to be implanted.

Wound Closure and Dressing

After your new, prosthetic joint has been successfully implanted, your surgeon will close the wound, using sutures to help the incision heal. They will then dress your elbow to ensure it is properly protected.

How Much Does an Elbow Replacement Cost?

How much a patient will pay for an elbow replacement is dependent upon the amount of health coverage they have, as well as any surgical fees or additional rates their orthopedic specialist may require.

Without coverage, the average estimated cost for a total elbow replacement in the United States is between $35,000.00 and $40,000.00.

Some practitioners offer discounts for patients who do not have coverage, so it is always a good idea to consult with multiple specialists to determine which option would be most affordable for you.

How Long is the Elbow Replacement Recovery Process?

Many patients are able to begin using their arm at 12 weeks post-surgery. However, in some cases, it can take up to a year to regain a full range of motion.

For athletes and professionals who use their arms frequently for work, the timeline can vary.

Only your physician can accurately predict how long it will take for you to meet your individual goals.

Why Choose ShoulderMD?

With nearly 20 years of experience studying and treating orthopedic conditions, Dr. Schwartz is completely board certified (American Board of Orthopaedic Surgery), is a Fellow of the American Academy of Orthopaedic Surgeons, and is also a candidate member of the American Shoulder and Elbow Surgeons Society.

But the greatest evidence of Dr. Schwartz’ skill and qualifications comes from his patients, who have witnessed first-hand just how dedicated he is to providing specialized, industry-leading care.

We encourage you to browse our testimonials page and see for yourself.