Risk factors for reoperation after total elbow arthroplasty.
BACKGROUND
Total elbow arthroplasty (TEA) is a treatment option for arthritic conditions of the elbow and for complex distal humerus fractures in the elderly. Complications are common, however, and rates of survivorship vary. The goal of this study was to describe the factors associated with reoperation and revision after TEA.


METHODS
We retrospectively reviewed primary TEAs performed at 2 tertiary academic medical centers. We identified 102 primary TEAs in 82 patients by 9 surgeons. The average age of the patients was 61 years. Female patients represented 81% of TEAs performed. The mean follow-up was 6.1 years. The principal diagnosis was inflammatory arthritis in 63 patients (62%), acute trauma or post-trauma in 28 (27%), and primary osteoarthritis in 9 (8.8%).


RESULTS
The rate of reoperation was 41% (42 of 102). The median time to the first reoperation was 1.8 years. The percentage of elbows that had 1 or both components revised was 30% (31 of 102). The most common indication for reoperation was component loosening (17). Six elbows were treated definitively with resection arthroplasty, and 1 was revised to an elbow fusion. The rate of implant revision was 27% for inflammatory arthritis, 11% for osteoarthritis, and 57% after trauma. Trauma-related TEA was more likely to undergo additional reoperation (odds ratio, 4.3; P = .008) and implant revision (odds ratio, 3.4; P = .031).


CONCLUSIONS
Revision surgery with implant revision after primary TEA is common. Trauma-related TEA often leads to additional procedures.
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Donato
D
Perretta
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Wouter F
WF
van Leeuwen
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
George
G
Dyer
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
David
D
Ring
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: nchen1@partners.org.
Neal
N
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000601:surgery; D057929:Arthroplasty, Replacement, Elbow; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D000092464:Elbow Injuries
Elbow arthroplasty; complications; elbow arthritis; revision elbow arthroplasty; rheumatoid arthritis; total elbow