I have a fracture at the bottom of my humerus that hasn’t healed in six-months and likely isn’t going to heal. The surgeon calls this a “nonunion” fracture. I am being encouraged to consider having an elbow replacement. The other option is surgery to pin or wire the broken bones together in hopes that might help with healing. What do you recommend?

There was a recent article in a prominent orthopedic journal that focused on the past, present, and future of total elbow arthroplasty (TEA) or elbow replacement. The surgeons who wrote the article (from the Department of Orthopaedic Surgery at Thomas Jefferson University in Philadelphia had some information to offer that might be helpful to you.

First of all, it is important to know that elbow implants have been around for 30 years. They were first designed for adults with rheumatoid arthritis. But over the years, as the implant materials and technology have changed and improved, younger, more active adults with elbow arthritis following trauma, failed surgery to fix an elbow fracture, or after removal of tumors have become acceptable candidates as well.

Surgeons now have different pathology-specific implant options. In other words, they can choose the implant design that best suits the patient’s problem. The goals of elbow replacement include: pain relief, improved elbow motion, and improved function. Total elbow arthroplasty (TEA) is also an option in cases where fractures have failed (as in your case) to heal or healed poorly resulting in malunion and deformity.

The authors suggest that the use of total elbow arthroplasty (TEA) instead of internal fixation (pinning, screwing, or wiring the pieces together) is a good idea for some patients. The patients experience immediate improvement in motion and function. But studies show a high rate of complications (43 per cent) and reoperations (35 per cent).

Early on there can be loosening of the implant from osteolysis (bone cells dissolve), infection, bone fracture around the implant, and weakness of the triceps muscle, which is cut in order to put the implant in place. Less severe but more common complications include wounds that don’t heal and damage during the surgery to the local nerves and blood vessels.
Later on, wear on the polyethylene (plastic) portion of the implant can lead to problems.

Present-day implants can provide major improvements in pain, motion, and function. Some studies have already shown a benefit for TEA over fixation with hardware. The hope for future implants is a more stable joint with a lower failure rate and fewer problems and complications. Studies with long-term results are not yet available (but eventually will be!) based on implants in current use to give us an idea of what is possible for individuals like yourself.