Journal of shoulder and elbow surgery
May 12, 2026 · via Europe PMC
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.
AI summary — for doctors, generated from the abstract only
Elective primary total elbow arthroplasty gives meaningful pain, function and motion benefits, but revision and reoperation rates remain high and have not improved over decades.
What was studied
Systematic review of studies from the last 25 years reporting functional and safety outcomes of elective primary total elbow arthroplasty in at least 10 cases, excluding trauma and revision procedures. Outcomes were pooled separately for short-, mid- and long-term follow-up.
Key findings
- 76 studies with 4,254 elbow replacements (mean age 59 years, mainly rheumatoid arthritis) were included
- At long-term follow-up weighted means were pain VAS 1.9, Mayo Elbow Performance Score 82, DASH 43, flexion-extension arc 106 degrees and pronation-supination arc 137 degrees
- Late survivorship was 86.3%, with deep infection 3.2%, all-cause reoperation 16.8%, periprosthetic fracture 6.8%, persistent ulnar nerve symptoms 5.8% and dislocation of unlinked implants 5%
- Semiconstrained prostheses had a slightly higher reoperation rate than unlinked (18.6% vs. 15%), and other outcomes were very similar
Clinical relevance
This helps counsel patients: elbow replacement can relieve pain and improve function, but they should be told about a meaningful chance of complications and reoperation.
Who should care
Limitations
Pooled weighted means come from heterogeneous, mostly observational studies, and reporting of complications varies. The abstract does not give study quality, confidence intervals or comparisons with non-surgical care.
Total elbow arthroplasty works but with persistently high reoperation rates.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
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. 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 4,254 TEAs (mean age 59 years). The main indication was rheumatoid arthritis. Meaningful improvements were observed in all efficacy outcomes (weighted means): at long-term follow-up (>5 years of mean follow-up), pain visual analog scale was 1.9 points, Mayo Elbow Performance Score was 82 points, Disabilities of the Arm, Shoulder, and Hand scale was 43 points and total flexion-extension and pronation-supination arcs were 106 and 137°, 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 (intraoperative and/or postoperative) 6.8%, persistent ulnar nerve paresthesia/dysesthesia 5.8% and dislocation of unlinked implants 5%. Subgroup analyses of rheumatoid arthritis/inflammatory arthritis patients found similar efficacy and safety outcomes to the overall population. All outcomes were very similar between unlinked and semiconstrained prostheses except for a slightly higher reoperation rate in favor of the semiconstrained group (weighted mean 18.6% vs. 15%).
Conclusion
Elective primary TEA confers meaningful benefits with regard to pain relief, function and range of motion; however, it is associated with high revision and reoperation rates which remain static over the past decades.
DOI
10.1016/j.jse.2026.04.055
PMID
42128287
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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