Total Elbow Replacement (TER)

Описание: Total Elbow Replacement Surgery (TER) is a procedure designed to restore function and alleviate pain in patients with severe elbow damage, typically due to arthritis, fractures, or joint degeneration. The surgery involves replacing the damaged parts of the elbow joint with artificial components, consisting of metal and plastic parts that mimic the motion of a healthy elbow.

Surgical Process:

1. Incision and Exposure: A cut is made at the back of the elbow to expose the damaged joint.

2. Resection: The ends of the humerus (upper arm bone) and ulna (forearm bone) are removed to prepare the bone for implant fixation.

3. Implantation: Metal components, typically made from cobalt-chromium or titanium, are inserted into the humerus and ulna. These components are connected by a metal hinge, which allows for flexion and extension. A plastic spacer may be placed between the metal parts to ensure smooth movement.

4. Fixation: The implants are either cemented into the bones using bone cement or press-fitted to allow bone to grow into the prosthetic parts.

5. Rehabilitation: Post-surgery, patients begin rehabilitation to regain motion and strength, gradually returning to daily activities over the following months.

Indications:

Rheumatoid Arthritis: TER is frequently performed for advanced rheumatoid arthritis. About 50-70% of TERs are performed in patients with this condition.

Post-Traumatic Arthritis: TER is recommended for patients with severe joint destruction after elbow fractures.

Osteoarthritis: Though less common, TER may be indicated in patients with primary osteoarthritis.

Elbow Fractures: Particularly for complex distal humerus fractures in older adults, TER may provide better functional outcomes than fracture fixation.

Rehabilitation:

Immobilization: The elbow is typically immobilized in a splint or brace for the first 6-8 weeks post-surgery to protect the implant.

Physical Therapy: Patients begin gentle range-of-motion exercises early in the recovery period, but strength training is usually delayed until about 6-8 weeks after surgery.

Return to Activities: While most daily activities can be resumed after about 3-6 months, patients are advised to avoid heavy lifting and high-impact activities indefinitely to prevent implant failure.

Conclusion:

Total elbow replacement surgery offers a highly effective solution for pain relief and restoring elbow function in patients with severe joint damage. While the surgery provides good outcomes for most, it carries a higher risk of complications and implant failure compared to other joint replacements, making it crucial for patients to adhere to postoperative guidelines to maximize the lifespan of the implant and avoid revision surgery.