Total elbow arthroplasty

Introduction

Although the first resection and interposition arthroplasties of the elbow were reported at the beginning of the 20th century, modern total elbow arthroplasty (TEA) started in the late 1960s with a cemented hinge design described by Dee and Sweetnam.^1–3 Since then, other implants have been introduced with advances in design.⁴

Total elbow arthroplasty can be used to treat elbow joint pathology such as rheumatoid arthritis (RA), osteoarthritis (OA), trauma, and post-traumatic sequelae.^5–7 In addition, TEA is used in rarer conditions, such as in haemophilic arthropathy, as well as in tumour reconstruction.^8,9 From the early 1970s to the late 1990s, RA was the most common indication globally for TEA. In this millennium, the development of effective biologic drugs such as anti-TNFα – a medication for treatment of RA – has resulted in a marked decrease in the number of TEAs (Fig. 1).^5–7,10,11 Simultaneously, TEA has been used more and more to treat primary osteoarthritis and post-traumatic sequelae such as instability, as well as acute elbow fractures in elderly patients who are both increasingly frail and have greater functional demands.

Compared with lower limb arthroplasty, TEA can be considered an uncommon procedure, with an annual incidence of 1.4 per 100 000 people in Western countries.^12,13 In Europe, TEA incidence has slightly but constantly decreased from the late 1990s (Fig. 1).^12,14 Conversely, in the United States there has been an annual rise of 6.4% between 1993 and 2007, from 1000 to 2400 procedures per year. This has been projected to continue in the future.^15,16 In addition, TEA is used more and more often to treat the conditions of younger patients, and there has been growing interest in the causes of complications and revision surgery.^4,12,16–20