Elbow brace - Ortokinetic

Elbow brace

Although the elbow prosthesis is less common than knee or hip prosthesis, it is just as successful in relieving joint pain and allows the patient to return to normal activities.

ANATOMY

The elbow is a joint made up of 3 bones:

  • Humerus,
  • Ulna,
  • Radius.

The articular bone surfaces are covered with smooth cartilage, which protects the bones and allows them to move easily in the joint. A thin tissue called the synovial membrane covers all the remaining surfaces inside the joint. In a healthy elbow, the synovial membrane produces a small amount of fluid that lubricates the cartilage and eliminates almost any degree of friction when mobilizing the elbow.

DESCRIPTION OF THE ELBOW PROSTHESIS

In the elbow prosthesis process, the damaged parts of the humerus and ulna are replaced with artificial components. The prosthesis consists of a metal hinge and a plastic composite (strap) with two metal rods. The rods are inserted into the hollow part of the bone, called the canal.
There are different types of elbow prostheses and the components are of different sizes. There are also partial elbow prostheses.

INDICATIONS FOR TOTAL ELBOW PROSTHESIS

There are several conditions that can cause pain in the elbow and can cause elbow dysfunction, requiring elbow replacement surgery. These may include:
1. Rheumatoid arthritis
This is a condition in which the synovial membrane surrounding the elbow joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage to the point of total destruction of the cartilage, manifesting as pain and stiffness.
Rheumatoid arthritis is the most common form of inflammatory arthritis.
2. Artroza cotului (boala articulara degenerativa)
Artroza este o afectiune corelata cu varsta pacientului si se manifesta prin degradare progresiva a articulatiei. Apare de obicei la persoanele de peste 50 de ani, dar uneori poate sa apara si la tineri. Cartilajul care acopera oasele cotului se degradeaza progresiv ducand la frictiunea dintre oase. In timp, articulatia cotului devine rigida si dureroasa.
3. Artroza posttraumatica
Acest tip de artroza poate produce o disfunctionalitate severa a cotului. Fracturile oaselor care formeaza cotul sau rupturile tendoanelor si ligamentelor inconjuratoare, in timp, pot duce la leziuni ale cartilajului articular. Acest lucru provoaca durere si limiteaza functia cotului.
4. Fracturile severe
O fractura severa a unuia sau mai multor oase care alcatuiesc cotul, este un alt motiv frecvent de protezare al cotului. Daca fractura este cominutiva, poate fi dificil pentru chirurg sa refaca suprafata articulara. In plus, vascularizatia fragmentelor osoase fracturate poate fi intrerupta. In acest caz, chirurgul poate recomanda protezarea cotului. Pacientii in varsta, cu osteoporoza sunt cei mai expusi la riscul fracturilor severe de cot.
In addition, some fractures that are not perfectly reduced may require an elbow prosthesis to resolve the arthrosis that occurs.
5. Instabilitatea cotului
Instabilitatea apare atunci cand ligamentele care stabilizeaza articulatia, sunt deteriorate si nu isi mentin functia. Cotul este predispus la dislocare (instabilitate cronica).

PREPARING FOR SURGERY

Medical evaluation
If you decide to have elbow prosthesis surgery, your orthopaedic surgeon will request a set of blood tests and a rigorous physical examination.
Patients with chronic conditions, such as cardiovascular disease, should also be evaluated before surgery.
Medications
It is important to let your doctor know about any drug treatments you are taking. You may need to stop taking some medications before surgery. Medications such as non-steroidal anti-inflammatory drugs-aspirin, ibuprofen, most arthritis medications, anticoagulants should be stopped 2 weeks before surgery, as directed by your doctor.

SURGICAL PROCEDURE

To enter the elbow joint, the surgeon will make an incision on the posterior aspect of the elbow. After making the incision, the surgeon will gently remove the muscles to access the bone. After removing the scar tissue and calcareous deposits around the joint, the surgeon will prepare the humerus for the insertion of the metal component that will replace the damaged part of the distal humeral end. The same is done for the ulna.
The rods will be placed inside the humerus and ulna, and will be fixed into the bone with cement. The two rods will be connected to the joint with a metal clip. After suture, the postoperative wound is isolated with a sterile dressing.
Sometimes a drainage tube is left in place to drain postoperative secretions. This can be removed after the first 2 days, very easily, in the dressing room, without the need to re-enter the operating room.
Implants
Implants are made of a chromium-cobalt or titanium alloy and a polyethylene (plastic) component. The cement is made of polymethacrylate (acrylic).

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RECOVERY AFTER ELBOW PROSTHESIS

Postoperatively antibiotics will be given to prevent infection. Most patients are able to eat and get out of bed a few hours after surgery, when the anesthesia wears off. Hospitalization can vary from 2 to 4 days.
Pain management
After surgery it is normal to feel pain in your elbow as part of the healing process. Your doctor will prescribe anti-inflammatory and analgesic medication.

MEDICAL RECOVERY

It is essential to follow a careful recovery program to ensure the success of the surgery. Your physiotherapist will instruct and assist you in performing and learning exercises to help you recover as well as possible after surgery.
For the first 6 weeks after surgery, you will not be allowed to do heavy exercise.

WHAT COMPLICATIONS CAN OCCUR WITH ELBOW PROSTHESIS?

1.Infection – Infection can occur in any surgical intervention. It can occur in the hospital or after the patient is discharged or sometimes years later. Any infection in the body can affect the replaced joint. Minor infections are treated with antibiotics, while severe infections may require further surgery to clean out the infected site and remove the prosthesis.
2. Probleme legate de implanturi –desi implanturile si tehnicile chirurgicale continua sa avanseze, uneori unele componente se pot deteriora.
3. Afectarea nervilor
Nervii din vecinatatea protezei pot fi lezati in timpul interventiei chirurgicale, desi acest tip de afectare este foarte rar intalnit.
4. Vindecarea plagii
Este foarte important sa protejati incizia pentru a nu aparea probleme in vindecarea ranii.

LONG-TERM RESULTS

Most patients have experienced an improvement in their quality of life after total elbow joint replacement surgery (total prosthesis). There is less pain, increased range of motion and muscle strength, and the patient is able to perform all the basic activities of daily living. Contact sports and high-risk activities (horse-riding, climbing) and weight lifting should be avoided, as they increase the risk of weakening or damaging the components of the prosthesis or of periprosthetic fracture.

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