JSES - 2026-05-12 - Journal Article; Review
Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review.
Challoumas D, Wong TN, Barrett B, Tierney J, Little CP, Peach CA
Topics
Key Takeaway
Elective primary TEA achieves a weighted mean MEPS of 82 and long-term survivorship of 86.3% at ≥7 years, but carries a 16.8% all-cause reoperation rate that has not improved over 25 years.
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Summary
This systematic review assessed functional outcomes and complication rates of elective primary TEA across 76 studies (n=4,254) published over 25 years, excluding trauma and revision cases. At long-term follow-up, weighted mean pain VAS was 1.9, MEPS 82, DASH 43, flexion-extension arc 106°, and pronation-supination arc 137°. Late survivorship was 86.3%, with deep infection 3.2%, all-cause reoperation 16.8%, periprosthetic fracture 6.8%, persistent ulnar neuropathy 5.8%, and unlinked implant dislocation 5%.
Key Limitation
The dominant indication was rheumatoid arthritis, making it impossible to draw reliable conclusions about outcomes in osteoarthritis or post-traumatic arthritis patients who represent a growing elective TEA population.
Original Abstract
BACKGROUND
This systematic review evaluates the efficacy and safety of elective primary total elbow arthroplasty (TEA).
METHODS
A comprehensive literature search identified studies reporting functional and safety outcomes of primary elective TEA in ≥10 cases in the last 25 years. Studies reporting data on acute TEA for trauma and revision TEA were excluded. Primary outcomes included function, pain, and range of motion (ROM). Secondary outcomes were revision, reoperation rates and other complications. Revision and all efficacy outcomes were pooled separately for short-, mid- and long-term follow-up, which were based on mean follow-up of included studies.
RESULTS
A total of 76 studies were included with a total of 4254 TEAs (mean age 59 years). The main indication was rheumatoid arthritis (RA). Meaningful improvements were observed in all efficacy outcomes (weighted means): at long-term follow-up (>5 years of mean follow-up), pain visual analogue scale (VAS) was 1.9 points, Mayo Elbow Performance Score (MEPS) was 82 points, disabilities of the arm, shoulder and hand (DASH) scale was 43 points and total flexion-extension and pronation-supination arcs were 106 and 137 degrees, respectively. Weighted mean late survivorship (at least 7 years of mean follow-up; revision as endpoint) was 86.3%; weighted mean deep infection was 3.2%, all-cause reoperation 16.8%, periprosthetic fracture (intra- and/or postoperative) 6.8%, persistent ulnar nerve paraesthesia/dysaesthesia 5.8% and dislocation of unlinked implants 5%. Subgroup analyses of RA/inflammatory arthritis patients found similar efficacy and safety outcomes to the overall population. All outcomes were very similar between unlinked and semi-constrained prostheses except for a slightly higher reoperation rate in favour of the semi-constrained group (weighted mean 18.6% vs 15%).
CONCLUSION
Elective primary TEA confers meaningful benefits with regard to pain relief, function and ROM, however, it is associated with high revision and reoperation rates which remain static over the past decades.