Interpositional elbow arthroplasty (2023)

Interpositional elbow arthroplasty

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Interpositional elbow arthroplasty (1)


Elbow arthritis can be treated surgically through a procedure calledinterposition arthroplasty. The terminterpositionmeans that new tissue is placed between the damaged surfaces of the elbow joint. In this surgery, tissue is taken from another source to fill the space in the elbow joint. The soft tissue forms a false joint. This surgery has the best results in younger people with healthy tissue around the elbow joint.

This guide will help you understand

  • which parts of the elbow are affected
  • Why is this type of surgery used?
  • What happens during the procedure
  • what to expect before and after the operation


What parts of the elbow joint are affected?

The elbow joint consists ofthree bones: diehumerusarm bones andellemiRayforearm bones.

(Video) Arthritic Elbow Procedure

The ulna and humerus meet at the elbow and form a hinge. This hinge allows the arm to straighten and bend. The big oneTripleThe muscle at the back of the upper arm attaches to the tip of the ulna (theold screen). When this muscle contracts, it straightens the elbow. EITHERbicepsThe muscle at the front of the upper arm contracts to flex the elbow.

See animation of the hinge movement

See the animation of the biceps muscle moving the elbow

In the elbow joint, the bones are covered withArticular cartilage. Articular cartilage is a soft, smooth material. It protects the ends of the bones from friction when they rub against each other during movement of the elbow. Articular cartilage is soft enough to act as a shock absorber. It is durable enough to last a lifetime if not injured.

The connection of the radius with the humerus allows rotation of the forearm. The top of the radius is round. It rotates against the ulna and humerus while the forearm and hand rotate downward from the palm (pronation) with palm up (Assumption).

View elbow pronation/supination animation

Related document:Patient's Guide to the Anatomy of the Elbow


What does my surgeon hope to achieve?

The main goal of interposition surgery is to relieve pain associated with osteoarthritis when the joint surfaces of the elbow rub against each other. A piece of tendon or other soft tissue forms a spacer that separates the articular surfaces. Interposition arthroplasty is different from fusion surgery. The fusion simply brings the joint together and the elbow loses a lot of movement. Interposition arthroplasty can help reduce pain while the elbow joint retains some movement.

(Video) Anconeus Interposition Arthroplasty

Related document:Elbow Fusion Patient Guide


What should I do to prepare for the operation?

The decision to proceed with surgery must be made jointly by you and your surgeon. You need to understand as much as possible about the procedure. If you have any concerns or questions, you should speak with your surgeon.

Once you have decided to have the surgery, there are several steps you need to take. Your surgeon may suggest a complete physical examination by your GP. This exam will help ensure that you are in the best possible condition to undergo surgery.

On the day of surgery, you will likely be admitted to the hospital early in the morning. He must not eat or drink anything after midnight the night before.

surgical procedure

what happens during the operation?

The operation can last up to 90 minutes. You can perform an operation withgeneral anesthesia, which puts you completely asleep, orLocal anesthesia, which just numbs the arm. With local anesthesia, he may be awake during the operation, but your surgeon will make sure he cannot see the operation.

After receiving anesthesia, the surgeon will ensure that the skin on the elbow is free of infection by cleaning it with a germicidal solution. The surgeon will make aincisionalong the back of your elbow. The incision is made in the back because most of the blood vessels and nerves are on the inside of the elbow. Inserting them from behind helps prevent damage.

Then the tendons and ligaments are pulled apart. Special care is taken to move theulnar nerve, which goes from the elbow to the hand. Once the ends of the joint are exposed, the scar tissue becomes andbone spurs(small bony dots) are removed.

(Video) Animation of a primary elbow arthroplasty

The surgeon then shapes the ends of the elbow joint. This is done to allow space for new tissue between the articular surfaces.

The surgeon then removes a rectangular piecefascial tissueon the side of your thigh. (Fascia is a flat piece of connective tissue that surrounds muscles and organs.) This sheet of tissue is folded three times and sewn to the end of the humerus. the new fabricforms a cushionto separate the articular surfaces of the elbow.

Once the new piece of tissue is in place, the soft tissues are sewn together over the joint.

Interpositional elbow arthroplasty (2)

Metal pins are then placed into the humerus and ulna bones. The pins protrude through the skin. A hinged elbow brace is attached to the pins to easily hold the elbow joint surfaces apart. This device is worn for four to six weeks after surgery.


What can go wrong?

As with all surgical procedures, complications can occur. This is not intended to be an exhaustive list of complications. Some of the more common complications are

  • anesthesia
  • Infection
  • Damage to nerves or blood vessels

Problems can arise if the anesthesia given during surgery causes a reaction with other medications the patient is taking. In rare cases, the patient may have problems with the anesthesia itself. Also, anesthesia can affect lung function because the lungs do not expand as well while a person is under anesthesia. Be sure to discuss the risks and concerns with your anesthesiologist.


Each operation carries a small risk of infection. Interpositional elbow arthroplasty is no different. You may be given antibiotics before surgery to reduce the risk of infection. If an infection occurs, you will likely need more antibiotics to cure it. Additional surgery may be needed to drain the infection if it affects the area around the arthroplasty.

Damage to nerves or blood vessels

All the nerves and blood vessels that go to the elbow pass over or near the elbow joint. Because the surgery is done so close to the nerves and vessels, it is possible to injure them during surgery. If the injury was caused by the retractors pulling the nerves aside, the symptoms are usually temporary. Permanent damage to nerves or blood vessels is rare but can occur.

(Video) Chronic Elbow Dislocation | Interposition Arthroplasty with Tensor Fascia Lata

after the operation

What should I take into account after the operation?

After the operation, your elbow will be bandaged and supported by a mobile splint. The splint holds the joint surfaces slightly apart during healing. Your surgeon will want to check your elbow in five to seven days. The stitches are removed after 10 to 14 days, although most stitches have been absorbed by your body. There may be discomfort after the operation. Your surgeon may give you pain relievers to control the discomfort.

You should keep your elbow above the level of your heart for a few days to prevent swelling and throbbing. Keep your elbow propped up on a stack of pillows when sleeping or sitting.


What should I expect during my recovery period?

After the operation, you will wear the elbow brace for up to six weeks to give your elbow time to heal. Next, you'll likely see a physical or occupational therapist to guide your recovery program. You will need to attend therapy sessions for one to two months and wait up to four months for a full recovery.

Initial therapy treatments focus on managing pain and swelling after surgery. Heat treatments can be used. Your therapist may also use gentle massage and other manual treatments to relieve muscle spasms and pain.

Then begin low-impact range-of-motion exercises that can include active elbow movements and passive stretching.

Strengthening exercises serve to give additional stability to the elbow joint. As with any surgery, you should avoid doing it too quickly.

Some of the exercises you do are designed to make your arm work in a similar way to your work tasks and daily activities. His therapist will help him find ways to complete tasks that don't put too much stress on his elbow joint. Before your therapy sessions end, your therapist will teach you various ways to prevent future problems.

(Video) Total Elbow Arthroplasty for Distal Humerus Fractures

Your therapist's goal is to help you manage your pain, improve your strength, and maximize your range of motion. Once you're on the right track, regular visits to your therapist's office will be over. Your therapist will continue to be a resource to you. But you will be responsible for your own practice as part of an ongoing program at home.

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What is interpositional arthroplasty of the elbow joint? ›

Elbow arthritis may be surgically treated with a procedure called interposition arthroplasty. With interposition surgery, the surgeon places new soft tissue between the damaged surfaces of the elbow joint. The soft tissue forms a false joint.

What is an interposition arthroplasty? ›


Interposition arthroplasty is a salvage procedure that changes the morphology of the joint by placing tissue (autologous or allograft soft tissue such as muscle, tendon, skin) inside of the joint to provide a pivot surface upon which to pivot [133].

What are the different types of elbow arthroplasty? ›

There are two types of elbow implants: Linked (semi-constrained) or unlinked (unconstrained). With linked (semi-constrained) implants, the components of the implant are connected together.

What is the CPT code for interposition arthroplasty elbow? ›

Whether excisional arthroplasty is performed with an interposition tendon graft, tendon suspension, or allograft tightrope, all methods are reported with CPT code 25447, Arthroplasty, interposition, intercarpal or carpometacarpal joint.

Is arthroplasty same as joint replacement? ›

Arthroplasty comes from two Greek words — “arthro” means joint, and “plasty” refers to the process of molding or forming. In modern medical terms, arthroplasty refers to the surgical reconstruction or replacement of a joint. In other words, arthroplasty is the same thing as joint replacement surgery.

How long does it take to recover from elbow replacement surgery? ›

Recovery from elbow replacement surgery takes about three months. After healing from elbow replacement surgery, many people have less pain in the elbow with better mobility and function. Your doctor may tell you to avoid activities such as heavy lifting and contact sports after an elbow replacement.

Is arthroplasty a major surgery? ›

Arthroplasty is a major surgery and usually requires several weeks for recovery. Your surgical team will give you complete instructions on how to manage pain, promote healing, restrict activities and use any assistive devices – like a raised toilet seat, shower bench and/or walker – during recovery.

Does arthroplasty mean surgery? ›

Arthroplasty is a surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used. Various types of arthritis may affect the joints.

What is an Interpositional graft? ›

Vein graft interposition is performed to repair a vessel with a defect that does not allow tension-free end-to-end vessel anastomosis. 1. In 1907, Lexer et al2 first reported the usage of an autologous saphenous vein graft for bridging of an 8 cm axillary artery defect.

What is the ICD 10 code for total elbow arthroplasty? ›

Presence of left artificial elbow joint

Z96. 622 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z96. 622 became effective on October 1, 2022.

What is the CPT code for elbow arthroscopy? ›

CPT CodesCommon Procedures
Arthroscopic- Elbow
29830diagnostic, with or without synovial biopsy
29834with removal of loose body or foreign body
29835synovectomy, partial
78 more rows

What is the difference between CPT 27486 and 27487? ›

For a TKA revision (27486 Revision of total knee arthroplasty, with or without allograft; 1 component and 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component), watch for key words such as “removal and replacement of polyetheline liner” or “poly exchange,” and ...

What is the most common diagnosis treated with elbow arthroplasty? ›

Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients.

Is elbow surgery a major surgery? ›

Elbow replacement is major surgery with serious risks and potential complications. You may have less invasive treatment options.

How painful is a elbow Replacement? ›

After elbow replacement, most people have less pain than they did before surgery. Many people have no pain. Most people also have improved range of motion and strength.

How long does an arthroplasty last? ›

The usual estimate: 10 to 15 years

Rare complications requiring re-operation can occur soon after surgery; for others, a replaced joint can last two decades or more.

How long is arthroplasty surgery? ›

The surgical procedure can be completed within two hours. To perform a hip replacement, the surgeon: Makes an incision over the hip, through the layers of tissue. Removes diseased and damaged bone and cartilage, leaving healthy bone intact.

Does arthroplasty cure arthritis? ›

Knee surgery may temporarily relieve pain from arthritis, but it does not cure the condition. Managing your arthritis will still be necessary to reduce pain in the knees, even after joint surgery.

What can you not do after elbow surgery? ›

You cannot drive with a sling, bandages, or dressing as these could make you unsafe or invalidate your car insurance. After we give you permission to remove your sling and dressings, the elbow can still be a bit painful and stiff so usually it is not possible to drive safely until a few weeks after surgery.

How long is hospital stay after elbow surgery? ›

After Surgery

The length of stay in the hospital is approximately three to four days. Patients are given a splint on their arm to help stabilize their elbow. Physical therapy will also be prescribed to help gain strength and use of the arm. Most patients start to have use of their new elbow as soon as 12 weeks.

Do you wear a cast after elbow surgery? ›

After your procedure, you'll wear a splint for one week, followed by a cast. Several weeks after the surgery, your doctor will remove the cast and pins. Some surgeries for elbow fractures are outpatient, meaning you go home the same day. The extent of your surgery will determine whether or not you have a hospital stay.

Is arthroplasty painful? ›

Prodromes of Total Knee Arthroplasty Failure

Lonner et al 27 retrospectively reviewed 102 complicated TKA cases and assessed symptoms and associated radiographic findings. Pain and swelling were present in 84% and 76%, respectively.

What is the success rate of arthroplasty? ›

Very High Overall Success Rate

The success rate for this surgery is excellent, with greater than 95% of patients experiencing hip pain relief. The success rate of hip replacements after ten years from surgery is 90-95%, and 80-85% after 20 years.

What do you do after an arthroplasty? ›

Expect moderate to severe swelling in the first few weeks after surgery. You may also have mild to moderate swelling for 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling.

What are the complications of arthroplasty? ›

Possible Complications of Joint Replacement Surgery

Infection around the prosthesis. Blood clotting. Malfunction of the prosthesis (may be caused by wear and tear, breakage, dislocation, or loosening) Nerve injury (although rare, nerves in the surrounding area may become damaged during the surgery)

What are the two types of arthroplasty? ›

Surgeons can replace joints in any part of your body, but the most common types of arthroplasty are hip replacement and knee replacement. Most people who get this procedure need a total joint replacement.

How is an arthroplasty performed? ›

The procedure is performed in a hospital or outpatient surgery center. During the surgery, the damaged cartilage and bone is removed from your joint and replaced with prosthetic components made of metal, plastic, or ceramic. The prosthesis mimics the shape and movement of a natural joint.

What is an interposition graft made of? ›

Interposition grafts were constructed of Dacron (diameter, 8 mm). The proximal anastomosis was end-to-end to the external iliac artery if it was patent or to existing or newly constructed inflow bypass conduits if the external iliac artery was occluded.

How invasive is a bone graft? ›

Bone grafts are not an invasive procedure and any general dentist, oral surgeon, or periodontist can perform one. Some of these bone grafts may also involve the use of platelet rich plasma. The blood used for this process can be taken from you in a small sample.

What type of graft is permanent? ›

Autograft is skin taken from the person burned, which is used to cover wounds permanently. Because the skin is a major organ in the body, an autograft is essentially an organ transplant.

What are the types of arthroplasty? ›

What Are the Types of Arthroplasty? As mentioned, knee, hip, and shoulder replacement are common types of arthroplasty. The surgery is used for treating damage from: Rheumatoid arthritis.

What joints are most commonly replaced by arthroplasty? ›

Surgeons can replace joints in any part of your body, but the most common types of arthroplasty are hip replacement and knee replacement.

Is arthroplasty done to cure arthritis? ›

Surgery such as arthroplasty will not cure rheumatoid arthritis, nor will it stop disease activity. But if a joint is badly diseased, surgery may provide pain relief and improve function. Arthroplasty is considered when: Symptoms can no longer be controlled with medicine, joint injections, physiotherapy, and exercise.

What are the complications of elbow arthroplasty? ›

The most recognized complications include implant loosening, periprosthetic fracture, implant failure, infection, triceps insufficiency, and nerve palsy.

Do you have to wear a sling after elbow surgery? ›

During the first 2 weeks, you may remove your sling at home during the day but need to wear the sling in public (around other people) and when sleeping. After 2 weeks, the sling can be removed at all times.

What is the recovery for arthroplasty? ›

Depending on the type of arthroplasty you have, your full recovery can take up to four months. 6 You will be walking with a walker, crutches, or a cane in the first few days after surgery. Your healthcare provider will evaluate you a week after surgery and determine the specifics of your physical therapy program.

What is the easiest joint replacement? ›

Hip replacement surgery is a slightly more straightforward procedure than knee replacement. That's because the hip is a basic ball-and-socket joint. Therefore, it's a fairly straightforward process to create and implant parts to replace that joint effectively.

What is the average age for joint replacement? ›

In the United States, currently, the average age to undergo knee arthroplasty is around 65 years old. Mostly knee replacement surgery is performed in elders with severe arthritis, while those under the age of 50 are considered young and are asked to wait until the age of 65.

What are the symptoms of arthroplasty? ›

  • Increased pain or stiffness in a previously well-functioning joint.
  • Swelling.
  • Warmth and redness around the wound.
  • Wound drainage.
  • Fevers, chills and night sweats.
  • Fatigue.


1. Total Elbow Arthroplasty: Why and How
2. Total Elbow Replacement
(Orthopaedic Principles)
3. Total Elbow Arthroplasty
4. Joint Replacement: Elbow Arthroplasty
(Mayo Clinic)
5. Elbow Partial Arthroplasty Exam Review - Matthew L. Ramsey, MD
6. Elbow Replacement Surgery by orthopaedic surgeon Mark Vitale, MD
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