Total Elbow Arthroplasty from Indian Perspective: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• Total elbow arthroplasty (TEA) is a viable option for end-stage elbow arthritis, offering pain relief and functional restoration.
• Advancements in implant design and surgical techniques have broadened the indications for TEA beyond arthritis.
• Existing literature indicates favorable mid-to-long-term outcomes for TEA, but data specific to Indian patients is limited.

Purpose of the Study:

• To systematically review the outcomes of Total Elbow Arthroplasty (TEA) in the Indian population.
• To assess pain relief, functional outcomes, and range of motion following TEA in Indian patients.
• To identify common indications for TEA, complication rates, and implant removal incidence in this cohort.

Main Methods:

• A comprehensive literature search was conducted following PRISMA guidelines across PubMed/MEDLINE, Google Scholar, and Cochrane databases.
• Included were original English-language studies reporting outcomes of primary TEA in Indian patients.
• Data extraction focused on pain relief, functional scores (Mayo Elbow Performance Score), range of motion, indications, complications, and revision rates.

Main Results:

• Ten studies comprising 212 TEAs (Baksi's semi-constrained sloppy-hinged prosthesis) in 210 Indian patients were analyzed.
• Post-traumatic sequelae (58.5%) and distal humerus fractures (25%) were the primary indications for TEA.
• At a mean follow-up of 7.5 years, 80.7% achieved complete pain relief, with a mean Mayo Elbow Performance Score of 92.1.
• Weighted mean range of motion: flexion 122.6°, extension restriction 20.8°, supination 57.3°, pronation 48.6°.
• Overall complication rate was 32% (68 complications), with 6.6% (14 elbows) requiring implant removal.

Conclusions:

• Total elbow arthroplasty using Baksi's prosthesis yields satisfactory pain relief and functional outcomes in Indian patients.
• The complication and implant removal rates observed in this Indian cohort appear lower compared to other populations.
• TEA is a safe and effective treatment option for various elbow conditions in Indian patients, with favorable long-term results.