How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up

Authors

  • Jonathan P Evans Health & Policy Research Group, University of Exeter, Exeter; National Institute for Health Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter https://orcid.org/0000-0003-0090-1012
  • Jonathan T Evans Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol https://orcid.org/0000-0002-9464-6261
  • Hasan R Mohammad Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford; National Institute for Health Research Oxford Biomedical Research Centre, Oxford; 6 National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK https://orcid.org/0000-0002-2146-8601
  • Adrian Sayers Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol
  • Ashley W Blom Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
  • Michael R Whitehouse Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK https://orcid.org/0000-0003-2436-9024
  • Jonathan L Rees Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford; National Institute for Health Research Oxford Biomedical Research Centre, Oxford

DOI:

https://doi.org/10.2340/17453674.2022.2753

Keywords:

Arthroplasty, Elbow, Patient reported outcome measures, survival analysis, total elbow replacement

Abstract

Background and purpose: This study aims to determine, for the first time, generalizable data on the longevity and long-term function of elbow replacements.
Methods: In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles reporting 10-year or greater survival of total elbow replacements (TERs) and distal humeral hemiarthroplasty. Implant survival and patient reported outcome measures (PROMs) data were extracted. National joint replacement registries were also analyzed. We weighted each series and calculated a pooled survival estimate at 10, 15, and 20 years. For PROMs we pooled the standardized mean difference (SMD) at 10 years.
Findings: Despite its widespread use, we identified only 9 series reporting all-cause survival of 628 linked TERs and 610 unlinked TERs and no series for distal humeral hemiarthroplasty. The studied population was treated for rheumatoid arthritis in over 90% of cases. The estimated 10-year survival for linked TERs was 92% (95% CI 90–95) and unlinked TERs 84% (CI 81–88). 2 independent registries contributed 32 linked TERs and 530 unlinked TERs. The pooled registry 10-year survival for unlinked TERs was 86% (CI 83–89). Pooled 10-year PROMs from 164 TERs (33 linked and 131 unlinked), revealed a substantial improvement from baseline scores (SMD 2.7 [CI 1.6–3.8]).
Interpretation: Over 80% of all elbow replacements and over 90% of linked elbow replacements can last more than 10 years with sustained patient-reported benefits. This information is long overdue and will be particularly useful to patients as well as healthcare providers.

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Published

2022-05-31

How to Cite

Evans, J. P., Evans, J. T., Mohammad, H. R., Sayers, A., Blom, A. W., Whitehouse, M. R., & Rees, J. L. (2022). How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up. Acta Orthopaedica, 93, 495–502. https://doi.org/10.2340/17453674.2022.2753

Issue

Section

Review, meta-analysis

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