Total elbow replacement (arthroplasty)
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Elbow replacement is a major procedure. Careful preparation, realistic expectations, and committed rehabilitation are all important for a good outcome. This guide takes you through each stage.
Step 1 - Your pre-operative assessment
ℹ️ This takes place 2–4 weeks before surgery and is a thorough medical review. Elbow replacement is a significant operation requiring careful anaesthetic and medical preparation.
You will meet the nursing, anaesthetic, and sometimes physiotherapy teams. Investigations are arranged to ensure you are fit for surgery.
Blood tests, ECG, and imaging review
Full blood count, kidney and liver function, clotting screen, and review of pre-operative X-rays and CT scan.
Medication review
Immunosuppressants for rheumatoid arthritis, blood thinners, and anti-inflammatories may need to be adjusted before surgery. Discuss this carefully with your surgeon and rheumatologist.
Anaesthetic discussion
General anaesthesia is standard for elbow replacement. A regional nerve block may also be used. You will be assessed for any cardiac or respiratory risk factors.
Dental check
Active dental infection before joint replacement surgery increases the risk of implant infection. See your dentist before surgery if any dental problems are present.
Permanent lifting restriction
Total elbow replacement carries a permanent restriction: patients are advised never to lift more than 1kg with the operated arm. This is a lifelong restriction to protect the implant. Plan accordingly before surgery.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Total elbow replacement carries a permanent lifting restriction of 1kg with the operated arm. This is not a temporary restriction - it is for life, and is essential to prevent premature loosening of the implant. Discuss how this will affect your daily life before proceeding with surgery.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
Pre-assessment and preparation
Full medical review, dental check, medication adjustment, and arranging home support.
Surgery and inpatient stay
The procedure takes 1.5–2 hours. Patients usually stay 1–2 nights. The elbow is placed in a posterior splint after surgery.
Splint removal and early movement
The posterior splint is removed at 1–2 weeks. Gentle active movement begins under physiotherapy guidance.
Progressive rehabilitation
Range of movement and gentle strengthening exercises. Avoid lifting more than 0.5kg during this phase.
Return to daily activities
Most daily activities can resume at 3–6 months. The permanent 1kg lifting restriction applies from this point onwards.
How long will I be in hospital?
Most patients stay 1–2 nights after elbow replacement. Discharge is when pain is controlled and you can safely manage at home.
What is the 1kg restriction?
Total elbow implants are not designed for heavy loading. Lifting more than 1kg risks loosening the components over time, which would require revision surgery. This restriction applies permanently.
When can I drive?
You should not drive until the elbow has sufficient movement and strength for safe vehicle control - usually at least 6–8 weeks after surgery. Your surgeon will advise when it is safe.
How long do elbow replacements last?
Modern elbow replacements last 10–15 years on average. Younger, more active patients may require revision surgery at some point. Your surgeon will discuss this with you.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
The primary aim of total elbow replacement is reliable pain relief. Improvement in functional range of movement is also expected. A permanent 1kg lifting restriction applies after surgery - this must be understood and accepted before proceeding.
What the procedure involves
Under general anaesthetic, the elbow is approached through a posterior incision. The ulnar nerve is identified and protected throughout. The distal humerus and proximal ulna articulating surfaces are removed and the medullary canals prepared. Cemented metal components are inserted into the humerus and ulna and linked by a hinge mechanism. The ulnar nerve is transposed anteriorly if required. The wound is closed over a drain.
Alternative treatments
Non-operative management
Analgesics, anti-inflammatory medication, physiotherapy, and activity modification. May provide adequate symptom control in some patients.
Arthroscopic debridement
For earlier-stage post-traumatic arthritis, arthroscopic osteophyte removal and capsular release may provide significant improvement and delay or avoid replacement.
Interpositional arthroplasty
Placement of a biological spacer (e.g. fascia lata) between the joint surfaces. An alternative for younger patients where long-term implant survival is a concern.
Risks of the procedure
The most feared complication. Deep infection may require removal of the implant, prolonged antibiotic treatment, and staged revision surgery. The risk is higher in rheumatoid arthritis.
The ulnar nerve is at risk during the surgical approach and closure. Symptoms include numbness and tingling in the ring and little fingers and weakness of grip. Most injuries are temporary neurapraxias but permanent injury is possible.
The triceps muscle is reflected during surgery and reattached at the end. Weakness of active elbow extension may persist.
Aseptic loosening of the humeral or ulnar component may require revision surgery. Adherence to the 1kg weight restriction reduces this risk.
Periprosthetic fracture of the humerus or ulna, occurring during surgery or subsequently. May require further surgery.
Delayed wound healing or wound breakdown, particularly in patients with rheumatoid arthritis or those on immunosuppressant medications.
Expected and managed with regular analgesia.
Normal after elbow surgery. Settles over 2-4 weeks.
Related to ulnar nerve handling during surgery. Usually resolves within weeks.
Some limitation of movement is common after elbow replacement. Physiotherapy addresses this from the first week.
If you choose not to have surgery
End-stage elbow arthritis causing significant pain and loss of function is unlikely to resolve without surgery. The permanent 1kg weight restriction is a lifelong commitment after elbow replacement and must be fully understood and accepted. If this restriction is not acceptable to you, alternative management strategies should be discussed.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is an elbow replacement?
Worn or badly damaged elbow joint surfaces, from arthritis or after a fracture, are replaced with an artificial joint to reduce pain and improve function.
Your choiceShould I have one?
It is considered when pain and stiffness are not controlled by medicines, injections and physiotherapy and your quality of life is affected. It reliably reduces pain, but comes with lasting activity limits, so a specialist discussion weighs the benefits and risks for you.
Implant lifeHow long does it last, and are there limits?
An important point: a replaced elbow has a permanent lifting limit, often only a few kilograms repeatedly, to protect the implant. Over time it can loosen or wear, and revision surgery is more complex. This is why elbow replacement is usually reserved for lower-demand use.
InjectionsDo injections help before considering replacement?
A steroid injection can give temporary relief and is sometimes used to manage symptoms or delay surgery, but the effect is usually short-lived.
Getting backWhat is recovery like?
Expect a period in a sling or splint, then guided movement and gradual strengthening within the lifting limits, with improvement continuing over months.
UrgentWhen should I seek urgent help after surgery?
Fever, spreading redness, wound discharge, severe or increasing pain, or new hand numbness all need prompt review. Infection is a particular concern with elbow replacements.
PreparingHow do I prepare?
You will have a pre-assessment to optimise your health, and you should arrange help and any equipment at home. Your team will explain the lifting restrictions you will follow for life.
WellbeingAdjusting to the lifting limits sounds hard.
It does take adjustment, but most people value the pain relief it brings. An occupational therapist can suggest practical ways to adapt everyday tasks within the limits.
- Versus Arthritis: osteoarthritis of the elbow and shoulder
- Versus Arthritis: elbow pain
- British Elbow & Shoulder Society: exercises for elbow stiffness
- British Elbow & Shoulder Society: patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.