Contemplating a total elbow arthroplasty (TEA)? Brace yourself. A recent study of 1, 299 TEAs performed on 1, 145 patients found that almost half required revision surgery at the 25-year point. Moreover, the cumulative risk for revision surgery increased at a constant rate beginning at year one.
Revision Rate Reported For Elbow Arthroplasty
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Jennie McKee reported on the study in the Daily Edition, AAOS Now. She noted that the investigators also took into consideration the type of implant and whether it had been cemented in or not. The factors associated with the highest revision rate were being younger than age 60 at the time of surgery, being male and having a primary diagnosis of posttraumatic arthritis (PTA). There were 104 males and 841 females in the study. They had a mean age of 60 years.
The authors of the study wrote that “315 elbows (24.3%) experienced revision surgery. The survival rate for all causes was 87.8% at 5 years and declined in a linear fashion reaching 52.9% at 25 years. Reasons for failure varied depending on different primary diagnosis.” They reported that, in elbows with underlying inflammatory arthritis as the primary diagnosis, deep infection was responsible for 31% of revisions. They added that mechanical reasons (breakage or wear) were responsible for 60% of revisions in patients who had posttraumatic arthritis.
The study authors noted that, “One of the most striking features of the 40-year data was the marked decrease in the proportion of TEAs being performed to treat inflammatory arthritis. From 1972 to 1981 more than three-fourths (77%) of the arthroplasties were performed for this condition.” This declined to less than half of TEAs in the period 2002 to 2011
They found that “implants in patients with inflammatory arthritis had significantly higher survival rates—up to 66% for all implant designs at 25 years
The title of the paper is “The Risk of Revision Surgery After Primary Total Elbow Arthroplasty: A Review of 1, 261 Elbows Over Four Decades.” Contributing authors: Suenghwan Jo, M.D., Ph.D.; Bernard F. Morrey, M.D.; Joaquin Sanchez-Sotelo, M.D., Ph.D.; and Mark E. Morrey, M.D.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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