Name of the Procedure:

Removal of Prosthesis, includes debridement and synovectomy when performed; Radial Head

Summary

This procedure involves the surgical removal of a prosthetic implant from the radial head of the elbow. The surgery may also include cleaning out any damaged tissue (debridement) and removing inflamed or excess synovial membrane (synovectomy) if needed.

Purpose

This procedure is performed to address problems with a previously placed radial head prosthesis, such as infection, loosening, or mechanical failure. The goal is to alleviate pain, resolve infection, and restore elbow function.

Indications

• Persistent pain in the elbow
• Infection at the implant site
• Implant loosening or dislocation
• Mechanical failure or wear of the prosthesis
• Limited range of motion
• Instability of the elbow

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuation of certain medications, especially blood thinners, as advised by the physician
• Preoperative blood tests, imaging studies (e.g., X-rays, MRI), and a thorough physical examination

Procedure Description

1. Anesthesia: Administered general or regional anesthesia.
2. Incision: A surgical incision is made over the elbow.
3. Exposure: The structures around the radial head are carefully exposed.
4. Prosthesis Removal: The prosthetic radial head is removed.
5. Debridement and Synovectomy: Any damaged or infected tissue is debrided, and inflamed synovial membrane is removed if necessary.
6. Closure: The incision is closed with sutures or staples.
7. Dressing: A sterile dressing is applied, and the arm may be placed in a protective splint or sling.

Duration

Typically, the procedure takes about 1 to 2 hours, depending on the complexity.

Setting

The procedure is performed in a hospital or surgical center, typically requiring at least an overnight stay for postoperative monitoring.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding or hematoma
• Damage to surrounding nerves or blood vessels
• Stiffness and limited range of motion
• Recurrence of symptoms requiring additional surgery
• Thrombosis (blood clots)

Benefits

• Relief from chronic pain
• Resolution of infection or mechanical issues with the prosthesis
• Improved elbow function and mobility
• Stabilization of the elbow joint

Recovery

• Initial rest and immobilization of the arm
• Pain management with prescribed medications
• Gradual reintroduction of movement through physical therapy
• Full recovery may take several weeks to months
• Follow-up appointments to monitor healing and progress

Alternatives

• Non-surgical treatments: Physical therapy, pain management strategies, corticosteroid injections
• Revision of the prosthesis instead of removal
• Elbow arthroplasty (joint replacement)

Each alternative has its own set of risks and benefits, and the choice depends on the specific condition of the patient.

Patient Experience

• During the procedure: The patient will be under anesthesia and will not feel pain.
• After the procedure: Some pain and discomfort are expected, manageable with medications.
• Postoperative care: Swelling, bruising, and restricted movement initially. Patients should follow rehabilitation protocols and attend all follow-up visits for optimal recovery.