My nephew is a young 40-something but already in need of an elbow replacement. Besides pitching ball for years, he has done construction for the last 20 years. Sounds like overuse and injuries has ruined the joint. My question is more of a worry/wonder because I had an elbow replacement about 10 years ago (I was considerably older than 40) and I can’t say it was a very good result. Not sure I would have done it if I had it to do over again. Should I say anything to him?

Joint replacement of hip, knee, and shoulder are commonplace now. Right behind those joints come ankle and elbow. 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. For example, younger patients who placed high-demand on their elbows (like your nephew) might do best with a distal humeral hemiarthroplasty (DHH) with unicompartmental radiocapitellar arthroplasty. This implant is also the one of choice for acute traumatic conditions.

Distal humeral refers to the bottom part of the upper arm (which forms the upper part of the elbow) and unicompartmental tells us only one-side of the bottom portion of the elbow is replaced (radial head). Radiocapitellar refers to the place where the radius (one of the two bones of the forearm) meets the bottom of the humerus.

The goals of elbow replacement haven’t changed much and include: pain relief, improved elbow motion, and improved function. But elbow replacement is still a challenging surgery to perform. The surgeon must position the implant correctly to restore the normal axis of motion and avoid overloading or wearing out the component parts. The use of computers to assist in accurate implant placement may help improve results.

The key area in need of improvement now is reducing complications associated with TEA. This is an area where your concerns may be very realistic. There is still a considerable amount of wear on the polyethylene (plastic) portion of the implant. Other complications and problems that can develop include 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. Overall, studies show a complication rate as high as 43 per cent with a minimum of 27 per cent. Almost one-third of patients have a second (revision or reoperation) surgery.

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 these individuals. Today’s patients will still benefit and the likelihood of a better result than even 10 years ago is very real.

Most likely the surgeon will review what your nephew can expect (including potential problems that can develop). He may receive a different type of replacement implant than you did, but it might not hurt to share your experiences. This would give him a point-of-reference for asking questions and raising concerns with his surgeon.