JSES - 2026-04-30 - Journal Article; Review
Nerve Injury in Revision Total Elbow Arthroplasty - A Systematic Review and Meta-analysis.
Tareen H, Fox M, Panagitidou A, Sinisi M, Simpson A
Topics
Key Takeaway
Revision total elbow arthroplasty carries a pooled nerve injury incidence of 22.3% (95% CI 16.3–29.6%), with the ulnar nerve involved in 66.7% and radial nerve in 31.7% of cases.
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Summary
This PRISMA-compliant systematic review and random-effects meta-analysis quantified nerve injury incidence, distribution, and recovery after revision TEA across 13 retrospective case series. Pooled nerve injury incidence was 22.3%; ulnar nerve was involved in 66.7% of cases and radial nerve in 31.7%. Among injuries with extractable recovery data, 85.4% improved partially or completely, though secondary nerve procedures were reported in 7 of 13 studies.
Key Limitation
Heterogeneous and non-standardized neurological outcome definitions across all 13 included studies prevented pooled recovery analysis for the full cohort and limit the reliability of the 85.4% improvement estimate.
Original Abstract
BACKGROUND
Revision total elbow arthroplasty is technically demanding and carries a substantial risk of postoperative neurological complications because of scarring, altered anatomy, implant removal, and repeated humeral and ulnar exposure. The incidence, nerve distribution, and recovery profile of nerve injury after revision total elbow arthroplasty remain incompletely defined. This study aimed to systematically review the literature to define the incidence, recovery profile, and risk factors for nerve injury after revision TEA.
METHODS
A systematic review of the literature was performed in accordance with PRISMA guidance. Thirteen retrospective case series were included, comprising 282 revision total elbow arthroplasties in 271 patients. Random-effects meta-analysis of proportions was undertaken where the data permitted. The primary outcome was postoperative nerve injury following revision total elbow arthroplasty. Secondary outcomes included nerve type, recovery, secondary nerve-related procedures, infection, triceps insufficiency, metallosis, periprosthetic fracture, and re-revision.
RESULTS
The pooled incidence of postoperative nerve injury was 22.3% (95% CI 16.3 to 29.6; I 2 = 34.6%). The crude incidence was 60 of 282 revisions (21.3%, 95% CI 16.6 to 26.5). The ulnar nerve was involved in 66.7% of all nerve injuries, the radial nerve in 31.7%, and the median nerve in 1.7%. No significant difference in pooled nerve-injury incidence was identified between studies published before 2010 and those published from 2010 onwards (22.9% vs 21.4%, p = 0.837). Recovery reporting was heterogeneous; among injuries with numerically extractable outcomes, 85.4% improved partially or completely (95% CI 72.2 to 93.9). Secondary nerve-related procedures were reported in seven studies. Pooled complication estimates were 10.2% for infection, 13.6% for triceps insufficiency, 25.5% for metallosis, 15.9% for periprosthetic fracture, and 14.0% for re-revision.
CONCLUSIONS
Postoperative nerve injury is a common and clinically important complication of revision total elbow arthroplasty, affecting approximately one in five cases. The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. Many neuropathies improve during follow-up, but persistent deficits and the need for secondary nerve-related procedures are not uncommon. Future studies should adopt standardised neurological definitions and reporting to improve comparability and guide preventive surgical strategies.