title: Why does total elbow arthroplasty fail today? A systematic review of recent literature.
abstract: BACKGROUND
  Total elbow arthroplasty is a relatively uncommon type of arthroplasty, which has undergone several design changes in the past four decades. However, research on improvement requires knowledge of failure mechanisms that can be addressed. Therefore, we conducted a systematic review on modes of failure of total elbow arthroplasty.
  
  
  METHODS
  We conducted searches on PubMed/Medline, Embase and Cochrane databases to identify studies describing modes of failure of primary total elbow arthroplasties. The results were coupled per type of total elbow arthroplasty and individual arthroplasty models.
  
  
  RESULTS
  A total of 70 articles were included in this systematic review. 9308 individual total elbow arthroplasties were identified with 1253 revisions (13.5%). Aseptic loosening was the most prevalent reason for revision (38%), followed by deep infection (19%) and periprosthetic fractures (12%).
  
  
  CONCLUSIONS
  Revision rates have been found similar to a systematic review published in 2003. The revision percentage of total elbow arthroplasty for rheumatoid arthritis is significantly higher than for trauma and post-traumatic osteoarthritis. Aseptic loosening was seen less in linked implants. Infections and periprosthetic fractures did not differ between linkage design groups. Aseptic loosening remains the most frequent cause for revision of primary total elbow arthroplasty. Therefore, more research on the occurrence, progression and risk factors of aseptic loosening should be performed and lead to higher implant survival.
authors.affiliation: Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands. aprkic@live.nl.
authors.forename: Ante
authors.identifier: http://orcid.org/0000-0002-2920-8564
authors.initials: A
authors.lastname: Prkic
authors.affiliation: Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Chantal
authors.initials: C
authors.lastname: Welsink
authors.affiliation: Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Bertram
authors.initials: B
authors.lastname: The
authors.affiliation: Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MPJ
authors.lastname: van den Bekerom
authors.affiliation: Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D057068:Periprosthetic Fractures / Q000209:etiology*; D011475:Prosthesis Failure; D016896:Treatment Outcome
keywords: Infection; Loosening; Review; Survival rates; Total elbow arthroplasty