This systematic review of 64 studies and 2,938 total elbow arthroplasties (TEAs) quantifies complication rates by prosthesis type and surgical indication. It addresses an 18-year gap since the prior major TEA complication review by Gschwend et al. The central question: have modern implants and techniques reduced the historically high TEA complication burden?
TEA carries a complication rate around 24% — multiple times higher than hip or knee arthroplasty. And that number should inform preoperative counseling for every patient.
The choice between linked and unlinked designs involves a direct tradeoff: unlinked designs reduce bone-cement interface stress but transfer that stability demand to periarticular soft tissue, which is often compromised in exactly the patients who need elbow replacement. The result is a nearly fourfold higher dislocation rate (4.9% vs 1.4%). Linked designs reduce instability but add bushing wear and disassembly as failure modes.
For post-traumatic arthritis patients, counsel aggressively. Their 37.5% complication rate is nearly double that of acute fracture patients and significantly higher than inflammatory arthritis. This is partly a selection bias (linked devices preferentially used in traumatic cases), but the indication itself independently predicts worse outcomes.
Two technical debates this paper addresses without resolving: routine ulnar nerve transposition shows a trend toward benefit but no statistical difference, and all three triceps approaches carry equivalent complication rates. Both decisions remain surgeon-preference calls pending higher-quality comparative data.
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This systematic review of 64 studies and 2,938 total elbow arthroplasties (TEAs) quantifies complication rates by prosthesis type and surgical indication. It addresses an 18-year gap since the prior major TEA complication review by Gschwend et al. The central question: have modern implants and techniques reduced the historically high TEA complication burden?
TEA carries a complication rate around 24% — multiple times higher than hip or knee arthroplasty. And that number should inform preoperative counseling for every patient.
The choice between linked and unlinked designs involves a direct tradeoff: unlinked designs reduce bone-cement interface stress but transfer that stability demand to periarticular soft tissue, which is often compromised in exactly the patients who need elbow replacement. The result is a nearly fourfold higher dislocation rate (4.9% vs 1.4%). Linked designs reduce instability but add bushing wear and disassembly as failure modes.
For post-traumatic arthritis patients, counsel aggressively. Their 37.5% complication rate is nearly double that of acute fracture patients and significantly higher than inflammatory arthritis. This is partly a selection bias (linked devices preferentially used in traumatic cases), but the indication itself independently predicts worse outcomes.
Two technical debates this paper addresses without resolving: routine ulnar nerve transposition shows a trend toward benefit but no statistical difference, and all three triceps approaches carry equivalent complication rates. Both decisions remain surgeon-preference calls pending higher-quality comparative data.