I had my elbow joint replaced about two years ago. It’s working pretty well. I don’t have full motion and somedays are more painful than others. But for the most part, it’s better than the terrible arthritis I had to put up with before the replacement. My problem today is that when I got out of bed this morning, I felt a distinct crack in my elbow I’ve never felt before. What could cause this?

Even though it has been two years since you had the elbow joint replacement and all has been well — a sudden symptom like this should be examined by your physician. It may be nothing more than a shift of muscle over bone but it’s important to rule out other potential problems.

You may need an X-ray to see how the implant is doing. An X-ray will show the placement of the implant and the condition of the bone. The X-ray will give some indication if there has been any bone loss around the implant with subsequent loosening of the implant.

And not to alarm you unnecessarily but there have been reports of bone fracture during normal activities in patients with elbow joint replacements. Usually there has been some severe bone loss around the implant leading up to this complication.

It’s not clear why this type of problem (bone loss around the implant and bone fracture) develops. It is currently being studied. One suggestion is that the problem comes from the type of implant used and in particular, the type of finish placed around the prostheses.

Some have a sprayed on layer of titanium plasma. Others have a beaded surface or precoat with a thin layer of polymethylmethacrylate (PMMA). It’s possible that these surface finishes (designed to help bone fill in around the implant) actually cause bone loss.

In any case, don’t put off notifying your surgeon of this symptom and requesting an immediate appointment. Let the scheduling staff who take your call know this isn’t a routine follow-up visit but something that needs to be looked at right away.