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Total Elbow Arthroplasty Complication, Reoperation, and Revision Rates: A Comparison Between Arthroplasty for Arthritis Versus Fracture
Evgeniy V. Uvarov, BS
1, Keyur Patel, BA
1, Anthony Castro, BA
2, Chris Sun, BA
2, Mohammad Khak, MD, MPH
2; Asif M. Ilyas, MD, MBA
1,2(1)Drexel University College of Medicine, Philadelphia, PA, (2)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: Total elbow arthroplasty (TEA) is used to treat various elbow joint issues such as distal humerus fractures and arthritis. This study aims to compare complication, reoperation, and revision rates following TEA between these two common indications.
Methods: A retrospective review of all cases performed at a single large orthopedic practice was queried for all patients who had undergone a TEA between 2016 and 2020, yielding 96 TEA cases for analysis. Cases were categorized by indication into arthritis diagnoses (AX group; n=54) and distal humerus fractures (FX group; n=42). Demographic and clinical data, including complications, reoperations, and revisions, were recorded over a four-year follow-up period. Reoperations were classified as component-sparing or component-related. Bivariate and multivariate analyses were performed to identify associated risk factors.
Results: A total of 96 patients with a mean age of 70.3 ± 12.4 years were screened, among whom 78.1% were female (75/96). Patients in the AX group were significantly younger than those in the FX group (64.8 ± 10.9 vs. 77.5 ± 10.5 years,
p < 0.0001). The overall complication rate was 41.7%, and the reoperation rate was 22.9%. Although not statistically significant, the AX group had higher rates of complications (44.4% vs. 38.1%) and reoperations (29.6% vs. 14.3%). Male sex was significantly associated with higher rates of both complications (76% vs. 33%,
p = 0.001) and reoperations (43% vs. 19%,
p = 0.045). Survival analysis for any reoperation at four years showed a borderline significant trend (p = 0.081) towards higher TEA for FX survival than for AX. No significant predictors were identified on multivariate analysis of comorbidities.
Conclusions: In the total TEA cohort, almost one-half of patients experienced complications and approximately one in four required reoperation within four years post-TEA. Despite advances in technique and implant design, TEA remains associated with substantial complication and reoperation rates. Surgical indication and patient sex may influence postoperative outcomes.
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