title: Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project.
abstract: OBJECTIVE
  Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications.
  
  
  METHODS
  We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship.
  
  
  RESULTS
  There were 1,146 primary TER procedures (incidence: 1.4 per 10(5) population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = -0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year.
  
  
  CONCLUSIONS
  The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, UK. pjenkins2@nhs.net
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Jenkins
authors.forename: Adam C
authors.initials: AC
authors.lastname: Watts
authors.forename: Tim
authors.initials: T
authors.lastname: Norwood
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: Lech A
authors.initials: LA
authors.lastname: Rymaszewski
authors.forename: Jane E
authors.initials: JE
authors.lastname: McEachan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects / Q000706:statistics & numerical data*; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011475:Prosthesis Failure / Q000639:trends*; D012086:Reoperation / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data; D055815:Young Adult; D000092464:Elbow Injuries