Cohort of 101 consecutive Nexel total elbow arthroplasties

The Nexel total elbow arthroplasty (TEA) was introduced as an enhancement of the Coonrad-Morrey TEA, which through design modifications aimed to improve patient outcomes. However, high revision rates due to loosening have been reported for this implant.

A review of 101 consecutive primary Nexel TEAs performed between 2015 and 2021 at a single institution was conducted using data from the Norwegian Arthroplasty Register, electronic medical records, and radiographic evaluations. Implant revision, other secondary surgery, and complications were investigated. Serial radiographs were examined for implant loosening using established criteria. Clinical outcomes, including Mayo Elbow Performance Score, range of motion, and pain, were assessed.

After an average of 44 (range 13-84) months from surgery to case review, 5 implant revisions were performed among the 101 cases, with 2 revisions related to aseptic loosening. Radiographic evaluation of nonrevised cases revealed an additional 4 cases of suspected aseptic loosening proportion. There were 38 secondary surgeries performed in 18 of 101 elbows and 27 complications in 22 of the elbows. Clinical outcomes were good or excellent in 81% of cases, including revised elbows, according to Mayo Elbow Performance Score classification. The mean flexion-extension arc was 113° at last follow-up vs. 87° preoperatively. Mean pain at rest (numerical rating scale) improved from 4.0 to 0.8 at last follow-up and pain during activity from 7.9 to 1.7.

There were 5 implant revisions performed among the 101 cases, 2 due to aseptic loosening. An additional 4 suspected aseptic loosenings were identified in serial radiographs. Reoperations and complications were frequent but within the expected range for TEA in a mixed population. Most of the patients showed a marked clinical improvement from the procedure, with the best results found among those with acute fractures and the least favorable in those with fracture sequelae.