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Please be a straight shooter and tell me what's the worst thing that could happen to me if I have an elbow joint replacement. I know these are new compared with hip and knee replacements. I'd like to know up front what to expect.

Any surgical procedure (elbow joint replacement included) can have small and/or large complications. The goal of any joint replacement surgery is to reduce pain, increase joint motion, and improve function. According to many studies, short- and long-term results for joint replacement (including rates of implant failure and post-operative complications) are best when the procedure is done in a high-volume hospital or clinic. High-volume means many of the same surgeries are performed there. Likewise, high-volume surgeons (those who do the same procedure hundreds of times) have the best results. Elbow joint replacement (called Total Elbow Arthroplasty or TEA) is possible but not a common procedure. Getting data on results of the TEA procedure to share with patients like yourself looking for information can be difficult. In a recent study from California, surgeons used information from the California Discharge Database to get a picture of short- and long-term outcomes for patients of all ages, race/ethnicity, and diagnosis (e.g., rheumatoid arthritis, osteoarthritis, traumatic arthritis). They found an overall complication rate of around 10.5 per cent. That means about one in 10 patients developed some kind of problem. Type of measures used to gauge success versus failure of the total elbow arthroplasty (TEA) included rates of infection, delayed wound healing, and need for revision surgeries or reoperations. Deaths (usually from blood clots) in the first three months were reported at a rate of 0.62 per cent. Other serious complications such as amputation and conversion to joint fusion were also included. Infections, wound complications, and blood clots headed the list of serious complications requiring hospital readmission. By nature of the thin soft tissues around the elbow, the rate of infection tends to be a problem no matter how careful the surgeon is. Most of these problems occurred early and meant the patient had to go back to the hospital for further care. On the positive side, 92 per cent of the implants did just fine and were still working well four years after being put in. You can ask your surgeon for a list of possible problems and the likelihood of those problems happening. Not everyone considers the different adverse outcomes as equal in severity. Whether death versus amputation are rated as "worse" than elbow fusion or continued pain is a matter of personal opinion. Knowing what to expect from good to bad is always a good idea in preparing for any surgery. We hope this information is helpful in your discovery and preparations.

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