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Giving injury the elbow

12 September 2017

When Bradley Passell damaged his elbow during a ‘rough and tumble’ schoolboy game he never thought the injury would plague him for the next 20 years.

Besides preventing him from swimming – one of his favourite sports - the injury eventually forced Bradley to give up his dream of becoming a chef.

But after years of pain and a series of operations and treatment 27 year old Bradley, who lives in Knaphill, Woking, is finally on the mend and steadily regaining almost full use of his arm following surgery to replace his damaged elbow.

Using the latest in ‘bone binding’ technology Orthopaedic Surgeon Mr Simon Lambert carried out the operation at Spire Bushey Hospital in Watford, where he was able to replace the elbow without having to secure the new components with cement as would normally be the case.

He explained: “The damaged surfaces of the elbow joint are removed and an artificial joint - made of plasma sprayed titanium alloy, and bearings made of cobalt-chrome and high density polyethylene - is inserted using stems to secure each component within the bone.

“The usual procedure would then be to cement the components into place to ensure a ‘good fit'. However, in Bradley's case, I used an implant that has surfaces with an ability to bind with bone and create a secure fitting without the need of cement.

“The surface roughness of the implant is ‘recognised’ by the body as being similar to the roughness of the bone. Cells from the bone move toward the rough surface of the implant and adhere to it as ‘spot-welds’ scattered along the surface.

 “It is an uncommon operation, particularly now that medical treatment for arthritis is becoming so successful. However, elbow replacement after injury and for severe fractures is becoming more common in the UK.”

When Bradley first injured his elbow he was fitted with a growth plate screwed into his humerus. Another injury at 14 meant he had a replacement plate fitted and at 21. He had the plate removed before undergoing a ligament reconstruction using a polyester weave, which was anchored to the radial and humerus.

Things didn’t seem to improve however, even following bone spur trim  - an operation in which excess bone at the margins of the joint surfaces are removed, smoothed, and the normal joint margins restored - and then the reconstruction of a ligament which helps to stabilise the elbow at the back and outer side.

 “By the time I met Mr Lambert I was at my wits end. I was in almost constant pain, I had given up a job as a chef which I was really enjoying, and I was finding it more and more difficult to bend my elbow to perform the simplest of movements,” said Bradley.

Mr Lambert, who has published over 70 papers and ten book chapters on shoulder and elbow conditions, explained that Bradley was very young to undergo such a procedure but that, because if the long-term nature of his injury it was felt that replacement surgery would provide the best outcome.

Elbow replacements have been performed in the UK since the early 1970's but the implant used on Bradley is a very recent design that was pioneered in the USA by Professor Hill Hastings.

Mr Lambert explained: “The emphasis in this design was the replication of the anatomic shape of the inside of the bone, for the best fit possible, and the replication of the axis for bending, which allowed for the normal helical movement of the natural joint during bending and straightening of the elbow.

“This was achieved with a novel mechanism for joining the two components together, which allowed for the normal slackness in the joint, while keeping the two parts of the joint located together. This mechanism permits less stress to be placed on the implants in the bone, so reducing the likelihood of loosening of the implants over time.”

He added: “Provided he recovers as expected and receives good physiotherapy then Bradley should experience almost complete relief of pain, while strength in the joint should improve to allow normal daily domestic activities and participation in some non-contact sports.”

Now Bradley is not only making a splash in the swimming pool but is also testing his hand in the kitchen as he gets back to ‘cheffing’ – this time on an amateur basis.

“It has been a long journey but I really feel like I am ‘on the mend’. It’s great to be back in the pool and my partner Lianne is delighted to see me back in the kitchen – she says is looking forward to me cooking up my speciality cheesecake. It will certainly be accompanied by a bottle of celebratory wine!” he said. 

 

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