JSES - 2026-08-01 - Journal Article
Cohort of 101 consecutive Nexel total elbow arthroplasties.
Eilertsen L, Brekke IF, Haavardsholm E, Storrønning I, Sand SM, Husby IE, Sexton J, Martinsen MI, Valland H, Lillegraven S, Fraser AN
Topics
Key Takeaway
At mean 44 months, the Nexel TEA yielded 5 revisions (5%) and 6 radiographic suspected aseptic loosenings (6/96 non-revised cases) with 81% good-to-excellent Mayo Elbow Performance Scores.
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Summary
This single-institution registry-supplemented review examined 101 consecutive primary Nexel TEAs performed 2015–2021 to characterize revision rates, complications, and clinical outcomes. Five implant revisions occurred (2 for aseptic loosening); radiographic review identified 4 additional suspected aseptic loosenings in non-revised elbows, yielding a combined loosening concern rate of approximately 6%. Clinical outcomes were good or excellent in 81% by Mayo Elbow Performance Score, with mean flexion-extension arc improving from 87° to 113° and pain during activity improving from 7.9 to 1.7 on NRS.
Key Limitation
Mean follow-up of only 44 months is insufficient to capture the full loosening burden for a linked semiconstrained TEA, where aseptic loosening rates typically accelerate beyond 5–10 years.
Original Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.