The patient may receive general anesthesia (unconscious, no pain) or regional anesthesia that prevents the arm from feeling pain. Patients receiving regional anesthesia are also given medicine to help them relax during the operation. The orthopedic surgeon makes an incision, usually in the back of the upper and lower arm, to expose the elbow joint. The surgeon removes the lower end of the bone in the upper arm (humerus) and the upper end of the large bone in the lower arm (ulna), along with any damaged tissue. The orthopedic surgeon then drills out a portion of the center of the humerus and ulna and inserts one stem of the prosthesis into each bone. Usually, bone cement is used to hold the stems in place. The surgeon then attaches the two stems together with the hinge system. The orthopedic surgeon closes the wound with stictches, applies a bandage, and might place the arm in a splint for stability.
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