Total elbow replacement. Information for patients Orthopaedics - Upper Limb

Transcription

1 Total elbow replacement Information for patients Orthopaedics - Upper Limb

2 Introduction The Upper Limb Unit team would like you and your family to understand as much as possible about the operation you are going to have. This booklet provides details about your surgery, and gives advice on your recovery and rehabilitation. Please feel free to ask any questions you may have at your next clinic appointment. There is space at the back of this booklet in case you want to write down your questions. What is total elbow replacement? The elbow joint is made up of three bones: humerus ulna radius The humerus is the bone in the upper arm, and the ulna and radius are the bones in the forearm. These bones join together at the elbow to form a 'hinge' joint. A total elbow replacement is an operation which replaces the worn surfaces of the humerus and ulna with new surfaces. page 2 of 12

3 Side view of the total elbow replacement Humerus (upper arm) Metal component Radius Elbow joint Ulna (forearm) Metal component Cement What are the main reasons for an elbow replacement? A total elbow replacement is used for people who have significant pain in the elbow and reduced elbow movement because of severe degenerative changes in the elbow, such as arthritis. Rheumatoid Arthritis is the main reason why elbow replacements are carried out. This is a type of arthritis that can affect many joints in the body resulting in pain and reduced movement. Osteoarthritis is 'wear and tear' arthritis which damages the joint surfaces. page 3 of 12

4 Occasionally an elbow replacement may be carried out following trauma to the elbow which has resulted in fractures involving the joint surfaces. What are the benefits of having an elbow replacement? It is normal to experience some pain after the operation but a total elbow replacement can relieve a lot of the pain you have previously experienced. In addition there may be some improvement in the range of movement of your elbow. It is unlikely you will get as much movement as in a normal elbow but due to the decreased pain you may be able to carry out functional activities more easily. How is the operation carried out? An elbow replacement is carried out under a general anaesthetic. It involves an incision along the back of your elbow and will leave a scar about 15cm long. Are there any risks associated with having a total elbow replacement? As with most types of surgery there are risks involved and complications can occur unrelated to the elbow replacement. These include: Anaesthetic risks Chest infections Blood clots in the legs (deep vein thrombosis) Blood clots in the lungs (pulmonary embolus) page 4 of 12

5 Some other complications, which can occur specifically following an elbow replacement are described below. These risks are very small but if any occur, further treatment or an operation may be necessary. Infection can be a serious complication. Some infections show up immediately whilst you are still in hospital, others are not obvious until you have gone home. To try and reduce this risk, it is normal practice to give antibiotics at the time of your operation. Loosening is one of the main reasons why joint replacements can eventually fail. On average you can expect your elbow replacement to last at least 5 years and hopefully more than 10 years before there is any significant loosening. Nerve damage can occur during the surgery as nerves pass close by the site of the operation. Damage can be temporary if retractors holding them out of the way stretch them. This could result in some reduced feeling or weakness in part of your hand making it difficult for you to use your hand. It is rare that permanent damage can occur, but it is possible. A fracture during surgery is very rare, but may require additional surgery or a slightly different prosthesis. There is a small risk of a peri-prosthetic (below the metal work) fracture after surgery; this is most likely to occur if you fall. What happens if I decide not to have an elbow replacement? If you decide not to have this surgery, further treatment will involve liaising with your GP to ensure you have adequate pain relief. What happens if I agree to a total elbow replacement? If you and your surgeon agree that a total elbow replacement is necessary, you will be asked to attend a pre-assessment clinic before your surgery to ensure you are fit for the operation. page 5 of 12

6 What will happen at the pre-operative assessment appointment? At the pre-operative assessment clinic the nurse will assess your state of health and will organise any necessary tests. This may include blood tests, urine tests, an ECG (heart tracings) and x-rays. Our aim is to start discharge planning at this appointment. We will ask you questions about your home situation. It is important for you to ask for any extra help that you feel you may need when you go home, so that plans can be set in place as soon as possible. This will help to avoid any unnecessary delays in you going home. Consent As with any procedure, we must obtain your consent beforehand. Staff will explain all the risks, benefits and alternatives before they ask for your consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information. When will I know the date of my operation? You may be given a provisional date at the pre-assessment clinic and this will be confirmed by letter. What instructions will I be given before my operation? You will receive a letter which will confirm your admission date. It will also include specific instructions you need to follow before coming into hospital. If you take regular medication you will be told at the pre-assessment clinic whether you should continue taking it as normal. page 6 of 12

7 How long will I be in hospital for? Following an elbow replacement you will generally be expected to remain in hospital up to a further 5 days. This is to ensure you are fit and well enough to manage at home, and also to start your post-operative rehabilitation. Will I have to wear a sling? For the first few days after the operation your elbow will be held straight in a plaster cast. When the cast is removed then you may be given a sling for a few days for comfort. You will be shown how to remove the sling carefully to wash and dress. How will I sleep? Sleep may be a little uncomfortable if you try and sleep on your affected side; we recommend that you lie on your back or on your opposite side as you prefer. Pillows can be used to give you comfort and support (feather pillows are easier to mould than foam ones). When can I drive again? Driving is a potentially hazardous activity and people will vary as to how soon they are able to drive safely. We advise you not to drive until you have enough movement and strength in your arm to control the car safely; you should not drive for at least 6 weeks following the operation. After this point you should return only after discussion with your surgeon. You should also inform your insurance company and the DVLA. page 7 of 12

8 What exercises will I need to do after the operation Whilst you are in hospital after your elbow replacement, the ward physiotherapist will begin your rehabilitation. This is very important if you want to get the most out of your new elbow replacement. When you go home you will need to continue with exercises the physiotherapist has shown you in hospital. Try the exercises shown below Take hold of the wrist on your operated arm and gently bend your elbow up towards your face and then gently straighten it back down as far as you can. With your operated elbow bent in at your waist, gently turn the palm of your hand to face upwards and then downwards to face the floor. page 8 of 12

9 Practise making a fist with your hand and then stretching your fingers out straight. Make sure your shoulder doesn t get stiff by lifting your arm up to the ceiling. page 9 of 12

10 What happens when I leave hospital? On discharge from hospital you will be seen in the outpatient clinic at approximately 2 weeks and then 6 weeks following your operation. You will be seen by the surgeon or one of their team, to check that your rehabilitation is going to plan. Your surgeon will then see you about 3 months after surgery and will then continue to review you once every year. When will my stitches be removed? Generally the stitches used are dissolvable, so you do not need a separate appointment to remove them. Any protruding ends will be checked at your clinic appointment at 2 weeks and trimmed if necessary. When can I assume normal activities? This depends on your symptoms. Most people are comfortable by 3 months after surgery, but will continue to improve for up to a year. You can start to use your arm for gentle activities such as feeding, dressing, personal hygiene as soon as you feel comfortable after surgery. Light activities such as sewing and knitting are best avoided until 6 weeks after your operation, and heavier work, such as digging and mowing the lawn must be avoided indefinitely. Heavy work or lifting must be avoided as it can weaken the elbow replacement and cause it to loosen - we advise you not to lift anything heavier than 1kg (1-2lbs). page 10 of 12

11 Is there anything I should look out for? It is important you seek further medical advice if you experience any of the following as they may be a sign of infection: Increasing pain Redness or swelling around the wound An increase in wound leakage/discharge Flu-like symptoms such as a high temperature and feeling unwell If you are worried or require further information, please contact your GP or the hospital on one of the numbers below. Who should I contact if I have any concerns? If you have any questions or concerns please don't hesitate to speak us. We can be contacted as follows: Consultant's secretary (Mr Thyagarajan) (Mr Potter) (Mr Ali) Therapy Services (Physiotherapy) (Occupational Therapy) Pre-assessment Clinic Patient Services Team PST@sth.nhs.uk page 11 of 12

12 Notes: Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD5303-PIL1746 v5 Issue Date: September Review Date: September 2019