Review Question - QID 5663

After total elbow arthroplasty for rheumatoid arthritis, a period of immobilization, such as use of a cast for 4 weeks, is preferred to early active motion. This decreases the risk of early complications.

Total elbow arthroplasty (TEA) is frequently done for patients with rheumatoid arthritis. Post-operatively, motion must be restricted to allow appropriate soft-tissue healing and prevent early complications. Early motion after total elbow arthroplasty is associated with wound complications, instability, and loosening of the implants. Immediate cast immobilization for 4 weeks has been shown to properly protect the elbow, and does not create an unacceptable loss of motion after removal of the cast. It is important to note that for a patient with osteoarthritis (OA), there is greater concern for postoperative stiffness. For a patient with OA who undergoes TEA, motion is usually begun at 2 weeks or when swelling allows.

Maloney et al. present a prospective cohort of 14 non-constrained total elbow arthroplasties performed in 11 patients. All patients were placed in a long-arm cast for 4 weeks, and subsequently allowed to return to activities as tolerated without formal physical therapy. At long-term follow-up they found acceptable range of motion despite the period of immobilization.

Illustration A is a lateral radiograph of a total elbow arthroplasty. Illustration B is a drawing of the posterior triceps reflecting approach to the elbow.

Incorrect answers:
Answer 2: Early immobilization is a preferred protocol for all patients following total elbow arthroplasty regardless of ability to follow restrictions.
Answers 3, 4, and 5: Early immobilization of a total elbow arthroplasty is not contraindicated and rather the preferred protocol. It does not produce a permanent loss of motion, create excess risk of compartment syndrome, nor is close monitoring of the surgical wound routinely required.