Elbow replacements have been highly successful for years. Many people who have suffered from elbow pain and arthritis have experienced relief through total elbow replacement and restored motion in their elbow. And because medicine is always developing new materials and procedures, the results continue to get better. The complication rate following total elbow replacement is low. Serious complications, such as elbow-joint infection, occur in as few as 5.0% of patients.¹ Major medical complications, such as heart attack or stroke, occur even less frequently. Of course, chronic illnesses may increase the potential for complications.

Every surgical procedure has some risks and benefits. Your individual results will depend on your personal circumstances, and recovery takes time. While there can be no guarantee of success, benefits can include pain relief and return of limited use of the elbow.

Each of the following reactions or complications can occur during and after surgery and may require medical attention, such as further surgery and implant removal:

Infection is a risk with any surgical procedure. According to a recent study, as few as 5.0% of patients get an infection in the first two years.¹ When infection occurs after total elbow replacement, it is most commonly caused by bacteria that enter the bloodstream during dental procedures or from urinary tract, skin, or fingernail infections. Although uncommon, when these complications occur, they can delay full recovery.

For the first two years after your elbow replacement, you may take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. Generally, talk to your orthopedist and your dentist to see if you still need preventive antibiotics before other procedures.

The bone next to the elbow implant may break down (called osteolysis) because of your body's reaction to particles that may be caused by:

• Direct contact of the metal and plastic components
• Contact between the elbow components and the bone cement
• Contact between the elbow components and your natural bone particles that exist between the elbow's moving parts, which can cause more particles or damage to the implant components

Implant fracture has been reported following total elbow replacement. This is typically caused by:

• Patients with extreme performance expectations
• Physically active patients

To minimize the possibility for implant fracture, it is important to follow medical instructions and to avoid excessive or inappropriate activity.

• Removal and/or replacement of the device system or its components may be necessary at some point in the future.
• Although rare, metal-allergy reactions from elbow implants have been reported. Inform your doctor if you have any allergy symptoms.
• Premature failure can result from improper positioning of the implant components.
• Implant components can loosen or move due to improper cementing or shock from falls or collisions.
• Cardiovascular disorders associated with the use of bone cement include blood clots, decreased blood pressure, heart attack, and in rare instances, death.
• May cause injury to nerves, muscles, or bone.

Given the risks, your doctor may decide that elbow replacement surgery is not appropriate if among others: 

• You have an infection or a history of infection
• You don't have enough bone or the bone is not strong enough to support your new elbow
• You have injured nerves in your elbow area
• You have injured or nonfunctional elbow muscles
• Your bones are not fully grown or developed
• You have noticeable bone loss or a severe decrease in bone mass (osteoporosis)
• Your elbow joint has been previously fused and is stable, functional, and painless
• You have rheumatoid arthritis and active/history of skin lesions (because of increased risk of infection)

Reference

1. Little CP, Graham AJ, Carr AJ; Total elbow arthroplasty: a systematic review of the literature in the English language until the end of 2003. J Bone Joint Surg Br. 2005 Apr;87(4):437-44.