Indications for total elbow arthroplasty revision: a systematic review

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Clinical Epidemiology

Background:

• Total elbow arthroplasty (TEA) is a reconstructive procedure for end-stage elbow disease.
• Revision surgery following TEA is a complex procedure with varying success rates.
• Identifying indications for revision TEA is critical for optimizing patient care.

Purpose of the Study:

• To systematically review and evaluate the primary indications for revision total elbow arthroplasty (TEA).
• To analyze the failure modes and reasons necessitating revision surgery after primary TEA.
• To provide updated insights into TEA failure mechanisms for improved clinical practice.

Main Methods:

• A systematic literature search was conducted across PubMed, Cochrane, and Embase databases up to July 9, 2024.
• Studies investigating reasons for revision surgery after primary TEA were included.
• Exclusion criteria included case reports, non-English studies, and articles not reporting revision indications.

Main Results:

• Out of 589 initial studies, 46 met inclusion criteria, analyzing 8,911 primary TEAs.
• Aseptic loosening (48.5%) was the most frequent indication for revision, followed by infection (19.4%) and periprosthetic fractures (10.3%).
• Higher revision rates were observed in patients with nonunion (24.7%) and inflammatory arthritis (13.4%) compared to traumatic injuries.

Conclusions:

• Despite advancements, TEA revision rates remain substantial, with aseptic loosening as a key failure mode.
• Broadened indications for TEA and inherent biomechanical challenges may contribute to high revision rates.
• This review underscores the need for improved patient selection, surgical techniques, and further research into TEA failure contributors.