Global trends in indications for total elbow arthroplasty: a systematic review of national registries

Abstract

National registries provide useful information in understanding outcomes of surgeries that have late sequelae, especially for rare operations such as total elbow arthroplasty (TEA). A systematic search was performed and data were compiled from the registries to compare total elbow arthroplasty outcomes and evaluate trends. We included six registries from Australia, the Netherlands, New Zealand, Norway, the United Kingdom and Sweden. Inflammatory arthritis was the most common indication for total elbow arthroplasty, followed by acute fracture and osteoarthritis. When comparing 2000–2009 to 2010–2017 data, total elbow arthroplasty for inflammatory arthritis decreased and total elbow arthroplasty for fracture and osteoarthritis increased. There was an increase in the number of revision TEAs over this time period. The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. However, inflammatory arthritis remains the most common indication in recent years. This change is accompanied by an increase in the incidence of revision surgery. Cite this article: EFORT Open Rev 2020;5:215-220. DOI: 10.1302/2058-5241.5.190036

Primary total elbow arthroplasty

“…Global trends from national registry data demonstrate that inflammatory arthritis continues to be the most common indication for TEA. 14 However, other indications particularly acute trauma, post-traumatic sequelae, and primary osteoarthritis have been gaining increasing popularity with regional variations. 14 A recent systematic review evaluating global trends from 6 national registry data (UK, Australia, New Zealand, Norway, Sweden, and the Netherlands) between 2000-2009 and 2010e2017 showed that the proportion of TEAs performed for inflammatory arthritis decreased from 61% to 46%.…”

“…14 However, other indications particularly acute trauma, post-traumatic sequelae, and primary osteoarthritis have been gaining increasing popularity with regional variations. 14 A recent systematic review evaluating global trends from 6 national registry data (UK, Australia, New Zealand, Norway, Sweden, and the Netherlands) between 2000-2009 and 2010e2017 showed that the proportion of TEAs performed for inflammatory arthritis decreased from 61% to 46%. 14 With a decreasing proportion of TEAs being performed for inflammatory arthritis due to advances in medical management, more TEAs are being performed for acute distal humerus fractures (23% vs. 38%), post-traumatic sequelae, and primary osteoarthritis (5% vs. 8%).…”

“…14 With a decreasing proportion of TEAs being performed for inflammatory arthritis due to advances in medical management, more TEAs are being performed for acute distal humerus fractures (23% vs. 38%), post-traumatic sequelae, and primary osteoarthritis (5% vs. 8%). 14 However, there are some notable regional variations. In the United States, Norway and Australia, an acute fracture is the most common indication for TEA ahead of both inflammatory arthritis and post-traumatic sequelae.…”

“…15e17 Moreover, primary osteoarthritis is a more common indication in Australia (33.9%), UK (33.2%), and Dutch (27%) registries compared to Scandinavian countries (3%). 14,16,18,19 A detailed discussion regarding patient's functional demands and expectations is of paramount importance when considering TEA. Although there are no published consensus recommendations for postoperative activity after TEA, many surgeons recommend lifelong postoperative activity restrictions to decrease wear and implant failure.…”

Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol

“…In recent decades, studies have reported an increasing number of TEAs performed globally. 24 This is partly due to the changing trend in indications for TEA, from primary and rheumatoid arthritis to acute trauma and post-traumatic deformities 24 and partly due to an ageing population. As the incidence of falls and fall-related injury increases with age, a further rise in the numbers of TEAs is expected.…”