Elbow Replacement
Total Elbow Arthroplasty (TEA)
Advanced joint replacement for severe arthritis and complex fractures
Understanding Elbow Replacement
Total elbow replacement is a highly successful procedure for the right patient. Unlike hip and knee replacements, elbow replacements have strict activity restrictions that must be followed for life, making patient selection critical.
Key Statistics
- • First performed in 1970s, significant advances since then
- • 10-year implant survival: 85-90%
- • Best results in rheumatoid arthritis patients
- • Pain relief achieved in >90% of patients
- • Functional arc of motion achieved in most cases
Lifetime Activity Restrictions
- • No repetitive lifting over 5 kg (11 lbs)
- • No single lift over 5 kg
- • No repetitive pushing/pulling over 1 kg
- • These restrictions are PERMANENT
Failure to follow these restrictions leads to loosening and implant failure.
Indications & Patient Selection
• Age >65 years with low physical demands
• Rheumatoid arthritis (best indication)
• Post-traumatic arthritis with severe pain
• Unreconstructable distal humerus fractures in elderly
• Failed previous surgery (revision)
• Willing to accept activity restrictions
• Young, active patients
• Manual laborers
• Active infection
• Paralytic or neuropathic conditions
• Insufficient bone stock
• Non-compliant with restrictions
Rheumatoid Arthritis
Most common indication. Excellent pain relief and function.
Acute Fractures
Unreconstructable distal humerus fractures in elderly. Alternative to complex ORIF.
Post-Traumatic OA
Severe arthritis following previous injury. Salvage option.
Implant Designs
Humeral and ulnar components connected by a hinge mechanism (sloppy hinge allows some rotation)
- • Provides inherent stability
- • More forgiving of soft tissue deficiency
- • Most commonly used design
- • Examples: Coonrad-Morrey, Discovery
Best for: Most primary and revision cases, ligament insufficiency
Components not mechanically linked; relies on intact soft tissues for stability
- • More anatomic kinematics
- • Requires intact collateral ligaments
- • Lower loosening rate theoretically
- • Higher dislocation risk
- • Examples: Kudo, Souter-Strathclyde
Best for: Select RA patients with intact ligaments
Surgical Procedure
Approach
- • Posterior midline incision
- • Ulnar nerve identification and protection
- • Triceps-sparing, triceps-reflecting, or triceps-splitting approach
Bone Preparation
- • Removal of arthritic surfaces
- • Humeral and ulnar canal preparation
- • Trial component placement
Implant Fixation
- • Usually cemented with PMMA
- • Humeral component placed first
- • Components linked after insertion
Closure
- • Triceps reattachment (if reflected)
- • Ulnar nerve anterior transposition considered
- • Drain placement, layered closure
Outcomes & Complications
Expected Outcomes
Complications
Mayo Clinic Series
The largest series of total elbow replacements comes from the Mayo Clinic. Their Coonrad-Morrey prosthesis has demonstrated excellent long-term results with 10-year survival of 92% in rheumatoid arthritis patients and 87% in post-traumatic arthritis.
Recovery & Rehabilitation
Evidence & References
• Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. JBJS Am 1992
• Schneeberger AG, et al. Total elbow replacement with the Coonrad-Morrey prosthesis. JBJS Br 1997
• McKee MD, et al. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. JBJS Am 2009
• Sanchez-Sotelo J, Morrey BF. Total elbow arthroplasty. J Am Acad Orthop Surg 2011
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)