Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project

Abstract

Background and purpose Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications.Methodology We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship.Results There were 1,146 primary TER procedures (incidence: 1.4 per 105 population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = –0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year.Interpretation The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty.

Total elbow arthroplasty is moving forward: Review on past, present and future

“…Large registries also raise the possibility to assess practical questions, for example, a recommended minimum of annual cases to retain optimal surgical results. The Scottish and Finnish arthroplasty registers show that highvolume specialized centers yield better implant survival [4,40] . Use of preoperative plain radiographs allows to plan implant size on beforehand, to optimize concordance between the preoperative native elbow joint and the arthroplasty.…”

“…By setting up large implant registries, trends in the longterm can be studied. In Scotland, Sweden, Norway, the Netherlands and New Zealand, data on elbow arthroplasties are reported on a routine basis [4,40,41] . If this could be expanded to more countries, larger cohort studies with better followups are possible [42] .…”

“…It is performed more often in women than in men [3] and is also used in relatively young patients [4,5] . The number of of TEA performed annually is 1.4 in 100000 of the population, considerably less than the 70 to 99 in 100000 of the population for total hip replacement [4,6] . The expanding practice of TEA leads to a new field in orthopedic surgery.…”

Establishing the Role of Unlinked Total Elbow Arthroplasty in Low Demand Patients: A Long-Term Follow-up Study

“…9 Revision rates can reach 15% at some mid-term studies. 10 Most studies are primarily based on short-term results, and currently there is no consensus on the best implant to use in different clinical settings. 10 Comparative studies between the different available implants seem to use non validated outcome measures what makes comparison difficult and results potentially unreliable.…”

“…10 Most studies are primarily based on short-term results, and currently there is no consensus on the best implant to use in different clinical settings. 10 Comparative studies between the different available implants seem to use non validated outcome measures what makes comparison difficult and results potentially unreliable. [11][12][13][14][15][16] There ś a demand to clarify the long-term performance of TEA in selected patient groups in order to throw more light on the relative roles of the available implants.…”