Medium Term Reoperation Rates after Primary Total Elbow Arthroplasty at a Single Institution: 303 Cases

Total elbow arthroplasty (TEA) is a definitive treatment for a broad spectrum of elbow pathology; however, durability remains limited by infection, aseptic loosening, and mechanical failure. As the indications for TEA continue to shift away from auto-immune etiologies and toward traumatic indications, it is important to assess the modern state of TEA long-term outcomes. However, large-scale contemporary data examining mid to long-term outcomes on TEA remains limited. The purpose of this study was to evaluate indications, complications and reoperation patterns following TEA.

A retrospective cohort study was conducted of all TEA patients performed between 2007 and 2025 at a single large tertiary referral center by eight fellowship trained shoulder and elbow and four fellowship trained hand surgeons. Inclusion criteria included primary TEA for any indication. Exclusion criteria included revision TEA arthroplasties or missing data from the electronic medical record (EMR). Patient demographics, comorbidities, indication, approach, and infection and revision data were obtained from the EMR. Patients with failed open reduction and internal fixations (ORIFs) and radial head replacements who then received a TEA were considered TEA for post-traumatic arthritis/malunion.

A total of 303 total elbow arthroplasties (TEAs) were analyzed, including 63 males (21%) and 240 females (79%), with a mean age of 68.4 ± 13.1 years (range, 21-94) and mean follow-up of 4.6 ± 4.2 years (range, 0.1-16.4). The most common indications were acute fracture (37%), autoimmune disease (30%), and post-traumatic arthritis/malunion (23%). The most common approaches were paratricipital (34%) and triceps-splitting (24%). Sixty-four patients (21%) underwent reoperation at a mean of 4.4 ± 4.0 years (range, 0.5-13.7). The most common indications for reoperation were infection (39%), humeral loosening (20%), bushing wear (13%), acute fracture (10%), and ulnar loosening (9%). Overall, 25 patients developed infection at a median of 2.5 years postoperatively (IQR, 0.36-5.78), of whom 13 underwent two-stage revision TEA and 12 underwent irrigation and debridement (I&D). There were no significant differences in infection rates by approach; this remained true after matching for diabetes, smoking status, and previous surgery (p =.761).

This study demonstrates that, despite advances in implant design and surgical technique, total elbow arthroplasty (TEA) continues to face substantial challenges, with a 21% reoperation rate at a mean 4.4-year post-operatively. Infection and aseptic loosening were the major causes of reoperation. These findings underscore the importance of careful patient selection, realistic preoperative counseling, and continued efforts to optimize implant longevity and surgical technique, particularly in younger patients.