Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review

This systematic review evaluates the efficacy and safety of elective primary total elbow arthroplasty (TEA). A comprehensive literature search identified studies reporting functional and safety outcomes of primary elective TEA in ≥10 cases in the last 25 years. Studies reporting data on acute TEA for trauma and revision TEA were excluded. Primary outcomes included function, pain, and range of motion. Secondary outcomes were revision, reoperation rates, and other complications. Revision and all efficacy outcomes were pooled separately for short-, mid-, and long-term follow-up, which were based on mean follow-up of included studies. A total of 76 studies were included with a total of 4,254 TEAs (mean age 59 years). The main indication was rheumatoid arthritis. Meaningful improvements were observed in all efficacy outcomes (weighted means): at long-term follow-up (>5 years of mean follow-up), pain visual analog scale was 1.9 points, Mayo Elbow Performance Score was 82 points, Disabilities of the Arm, Shoulder, and Hand scale was 43 points and total flexion-extension and pronation-supination arcs were 106 and 137°, respectively. Weighted mean late survivorship (at least 7 years of mean follow-up; revision as endpoint) was 86.3%; weighted mean deep infection was 3.2%, all-cause reoperation 16.8%, periprosthetic fracture (intraoperative and/or postoperative) 6.8%, persistent ulnar nerve paresthesia/dysesthesia 5.8% and dislocation of unlinked implants 5%. Subgroup analyses of rheumatoid arthritis/inflammatory arthritis patients found similar efficacy and safety outcomes to the overall population. All outcomes were very similar between unlinked and semiconstrained prostheses except for a slightly higher reoperation rate in favor of the semiconstrained group (weighted mean 18.6% vs. 15%). Elective primary TEA confers meaningful benefits with regard to pain relief, function and range of motion; however, it is associated with high revision and reoperation rates which remain static over the past decades.