Elbow surgery at Bournemouth Hospital

What is elbow surgery?

Elbow surgery is an operation on the bones, joints or soft tissues of the elbow, usually recommended when an injury or condition hasn't improved with other treatments. An orthopaedic surgeon carries it out, often using minimally invasive keyhole methods rather than a single larger cut.

What conditions can elbow surgery treat?

Elbow surgery can be used for a wide range of problems, including:

• arthritis, including osteoarthritis, rheumatoid arthritis, and arthritis that shows up years down the line after a fracture or dislocation
• fractures (broken bones) around the elbow
• tendon conditions such as tennis elbow and golfer's elbow
• trapped or compressed nerves, such as the ulnar nerve
• elbow bursitis (inflammation of the fluid-filled cushioning sac in the joint)
• stiffness and a significantly reduced range of movement
• loose fragments of bone or cartilage inside the joint
• torn ligaments, including the ulnar collateral ligament, often in throwing athletes.

What are the benefits of elbow surgery?

Surgery aims to reduce chronic pain and restore movement and function in the joint so you can get back to everyday activities.

Where keyhole surgery is an option, the smaller cuts tend to heal faster, involve a lower complication rate than open surgery, and let you start rehabilitation sooner.

For elbow replacement specifically, most people find their pain eases, their arm becomes more usable, and their day-to-day life is better for it.

Are there different types of elbow surgery?

The two broad approaches are:

• arthroscopy (keyhole surgery), where a tiny camera and narrow tools work through a few small cuts
• open surgery, where the surgeon makes one larger cut for direct access, more likely for urgent cases, complex injuries, or replacing the whole joint.

Depending on the problem being treated, specific procedures can include:

• elbow replacement (arthroplasty), replacing part or all of the joint with an artificial one made from metal and durable plastic
• open reduction and internal fixation (ORIF), repositioning and fixing broken bones with screws, pins, wires or plates
• osteotomy, cutting or reshaping bone to realign the joint or relieve pain
• synovectomy, removing the inflamed lining of the joint, often for rheumatoid arthritis
• bursectomy, removing an inflamed bursa to treat chronic elbow bursitis
• debridement, clearing out damaged or loose tissue
• cubital or radial tunnel release, freeing a trapped nerve
• tendon release or repair, including surgery for tennis elbow, golfer’s elbow, or a torn ligament.

What happens before elbow surgery?

Before surgery, you'll usually have a physical examination, blood tests, and imaging such as an X-ray, MRI or CT scan, so your surgeon has a clear picture of the joint. For some procedures, such as elbow replacement, you may also need a heart check (ECG) and a dental check to reduce the risk of infection.

• Tell your surgeon about all medicines and supplements you take, as you may need to stop some beforehand
• Don't eat or drink for around 12 hours before your admission, exactly as your surgical team advises
• Set up your home in advance so everyday items sit within easy reach, since normal use of your arm will be off-limits for some weeks
• if keyhole surgery is planned, physiotherapy beforehand can help by controlling pain and swelling and building strength in the muscles supporting your elbow.

What happens during elbow surgery?

1. You're given an anaesthetic, commonly a nerve block that numbs the arm on its own, sometimes paired with a general anaesthetic that keeps you asleep for the whole thing.
2. For keyhole surgery, your surgeon makes a few small cuts and inserts a tiny camera (arthroscope) along with narrow instruments to see inside the joint and carry out the repair.
3. For open surgery, your surgeon makes one larger incision to reach the joint directly, giving full access to repair, remove or replace the affected bone or tissue.
4. When the repair, removal or replacement work is finished, your surgeon stitches the wound closed and covers it with a dressing.
5. Many keyhole procedures, such as an elbow arthroscopy, take around 30 minutes, while more involved surgery, including a full elbow replacement, typically takes 1 to 2 hours.

What does recovery look like?

Whether you stay in hospital depends on the procedure. Many keyhole procedures, such as arthroscopy, are treated as day cases, meaning you're back home that same day after a short spell in the recovery room. More involved operations, particularly a full elbow replacement, usually mean an inpatient stay of a day or two.

Once home, you'll be shown how to care for your wound, manage pain, and wear any sling, splint or brace you've been given. Full use of the elbow stays off-limits for several weeks. Your surgeon and physiotherapist will give you advice about the movements you can do and an exercise programme to help rebuild strength and movement.

You are medically and legally prohibited from driving while wearing a supportive arm sling. You can only return to the road once the sling is fully discarded, you are off all sedating painkillers, and you possess full grip strength and unhindered upper-limb coordination to safely execute a sudden emergency steering maneuver. Following minor arthroscopy, this typically takes a minimum of 1 to 2 weeks, extending to 6 to 12 weeks for major open reconstructions. Please speak to your team about when you could return to driving.

After a full elbow replacement, full recovery can take up to a year, and you may be advised against lifting more than around 5 pounds (2.3kg) with that arm from then on, to protect the implant.

What are the risks and complications?

Elbow surgery is generally safe, but as with any operation there's a small risk of:

• blood clots
• infection
• excessive bleeding
• nerve injury, causing temporary numbness or tingling until it heals.

This means the elbow carries a somewhat higher chance of nerve injury and infection than surgery on bigger joints, simply because it's a small area packed with different tissues close together.

Elbow replacement carries some additional risks: fractures around the implant, wear or loosening of the prosthesis, and scar tissue that limits movement. About 15% of elbow replacement patients go on to need a further operation on the same elbow eventually, and this is more likely the younger you were at the time of your first operation. Conditions such as haemophilia, diabetes, osteoporosis or autoimmune diseases like lupus can also make recovery more difficult, so tell your surgeon if any of these apply to you.

Get in touch with your care team without delay if you notice a fever, unusual discharge from your wound, numbness or tingling, heavy bleeding or swelling, or pain that keeps getting worse.