Total Elbow Replacement

This leaflet provides general information to help you understand total elbow replacement (TER), an operation to replace a worn or damaged elbow joint with an artificial one.

This procedure replaces the worn elbow joint with a metal implant to relieve pain and restore function.

At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.

The Anatomy of the Elbow

The elbow is a hinged joint connecting the upper arm to the forearm, relying on several structures for stability and movement. The joint connects:

• Humerus (upper arm bone)
• Radius and Ulna (forearm bones)
• A smooth cartilage lining that can wear out

What Is Elbow Replacement?

The worn ends of the elbow joint are removed and replaced with a metal component for the humerus and a bushing around the ulna, which are then linked together.

Why It May Be Needed

Elbow replacement is most often advised for:

• Arthritis not helped by other treatments
• Severe pain limiting daily activities
• Some complex fractures in lower-demand patients
• Loss of function and movement

Common Symptoms

• Persistent elbow pain
• Stiffness and reduced movement
• Difficulty with everyday tasks
• Pain not relieved by injections

Other Options

Steroid or visco-supplementation injections and elbow arthroscopy are usually tried first. Replacement is considered when these have not helped and pain continues to affect daily life.

About the Operation

A 15–18 cm incision is made at the back of the elbow. The worn joint ends are removed and replaced with a metal implant, which is then linked together. The wound is closed with dissolvable sutures and a back slab (half cast) applied. Most patients stay one night in hospital.

At a Glance: Benefits

The operation aims to:

• Relieve the pain of a worn or arthritic elbow
• Restore smoother, more comfortable movement
• Improve function for everyday activities

The Procedure, Step by Step

• Incision: made at the back of the elbow
• Removal: the worn ends of the joint are removed
• Implant: metal components are fitted and linked together
• Closure: dissolvable sutures, dressing and a back slab

Before, During & After Surgery

Recovery & Results

Recovery is a partnership. The timeline below is a guide — your physiotherapist and I will adapt it to you — this shared decision-making process ensures you are fully informed and involved in your care.

• Back slab & sling: worn for about 2 weeks
• Exercises: begin before you go home
• Brace: an elbow brace may follow for 4–6 weeks
• Recovery: rehabilitation typically 4–6 months (up to a year)

An artificial elbow usually lasts 10–12 years. It can loosen sooner with heavy use, so lifelong care is needed to protect the implant.

After Surgery — The First Weeks

• Sling: a back slab and high-arm sling are used for about 2 weeks; a brace may follow for 4–6 weeks
• Pain Relief: the nerve block lasts 12–24 hours; start painkillers on returning home and take them regularly for at least 48 hours
• Wound Care: dissolvable sutures are tied over the skin and removed by the nurse at 14 days; keep the wound clean and dry
• Physiotherapy: a physiotherapist gives you exercises before discharge; rehabilitation typically takes 4–6 months and sometimes up to a year

Risks & Complications

Uncommon, but possible.

• Stiffness: mild stiffness is common; occasionally more marked stiffness can prolong recovery by a few months
• Infection: uncommon; may require antibiotics and, rarely, further surgery, and can shorten the life of the implant
• Persistent Pain: common for the first few weeks but steadily settles; ongoing pain after 3 months may need investigation
• Loosening: the implant usually lasts 10–12 years, then may need replacing; sooner with infection or heavy manual use
• Other Risks: occasional small bone cracks during surgery, usually mild and temporary nerve symptoms, or new bone formation (about 10%)

Return to Work & Living With Your New Elbow

Living with your new elbow — do’s and don’ts:

• Work: sedentary roles 4–6 weeks; jobs involving lifting 8–12 weeks
• Driving: usually 6–8 weeks, once comfortable with good movement; tell your insurer
• Lifting: never lift more than a glass of water for the first 6 weeks; avoid pushing up from a chair
• Sport: swimming 6–8 weeks (breaststroke first), golf around 12–16 weeks
• For life: avoid contact sports and repetitive heavy lifting to protect the implant

Questions You May Wish to Ask

• How long will the implant last?
• When can I drive and return to work?
• How much improvement can I expect?
• What can I safely lift and do?