Indications for total elbow arthroplasty revision: a systematic review.

Abstract

The purpose of this systematic review is to evaluate the indications for revision total elbow arthroplasty (TEA). The PubMed (MEDLINE), Cochrane, and Embase databases were queried for all studies published before July 9, 2024, that investigated TEA failure and reasons for revision surgery. Studies were included if they investigated revision surgery following TEA and reported indications for revision. Studies that did not report reason for revision, articles that studied outcomes after revision TEA rather than primary TEA, case reports, non-English studies, and abstract-only studies were excluded. A total of 589 studies were identified in the initial search, 46 of which met criteria for inclusion in the study. The eligible studies comprised a total of 8,911 primary TEAs, 1,166 (13.1%) of which required revision surgery. The most common reason for revision surgery was aseptic loosening (48.5%) followed by infection (19.4%) and periprosthetic fractures (10.3%). Patients who underwent primary TEA for diagnoses of nonunion and inflammatory arthritis had higher revision rates (24.7% and 13.4%, respectively) than patients who underwent TEA in the setting of acute traumatic injury or post-traumatic sequelae (9.7% and 9.2%, respectively). TEA revision rates have remained high despite technical advances and improvements in implant design. In this study, we found the most common mode of failure requiring revision to be aseptic loosening, which may be a consequence of the known biomechanical challenges inherent to elbow arthroplasty. A broadening of the indications for TEA in recent years has likely played a role, as well, and may have offset any gains derived from superior engineering and surgical technique. This updated information regarding failure mechanisms following TEA is important information for surgeons to counsel their patients on preoperatively and highlights the importance of close follow-up of high-risk patients. Overall, this systematic review highlights the need for future studies examining contributors to TEA failure.