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Arthroplasty & Implants

TEA for end-stage elbow arthritis/complex fractures: implant options, complication profiles, and revision considerations.

Overview

Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1]. Clinical outcomes for surface replacement trapeziometacarpal joint prostheses improved significantly in the short-term and remained excellent in the long-term for patients with stable implants [2]. Conversely, clinical outcomes for surface replacement trapeziometacarpal joint prostheses deteriorated clearly in cases of loosening [2]. Unicompartmental and bicompartmental arthroplasty of the knee with a finned metal tibial-plateau implant has a place in reconstructive surgery of the arthritic knee joint with proper indications [18].

Total elbow arthroplasty in patients with rheumatoid arthritis is associated with substantially higher implant failure and complication rates compared with hip and knee arthroplasties [24]. Trauma as an indication for total elbow arthroplasty appears to have increased complication rates compared with inflammatory arthropathy [4]. Contemporary total elbow arthroplasty has specific complications related to the implant of choice [4]. Continued advances in exposure, implant design, and complication management are key to making elbow arthroplasty as reliable and lasting as hip or knee arthroplasty [7].

Acute trauma is the most common indication for radial head arthroplasties [19]. The Radial Head System is the most commonly used implant for radial head arthroplasties [19]. Differences across fixed-stem radial head implants exist in revision rates, certain complications, and functional scores [9]. Heterogeneity of implant type, patient characteristics, and outcome measures, along with inadequate reporting of study details, restricts definitive conclusions regarding functional outcomes post-radial head arthroplasty [8].

Total elbow arthroplasty requires rigorous monitoring. Long-term surveillance of primary linked total elbow arthroplasty identifies all failing implants requiring revision [3]. None of the failing implants requiring revision in primary linked total elbow arthroplasty were identified via patient-initiated review [3]. DES polyethylene bearing exchange provides management principles, successful and reproducible surgical techniques, and expected clinical outcomes for surgeons managing Discovery Elbow System arthroplasty [25].

Device manufacturers must design devices that are usable and affordable in emerging markets by addressing regional anatomic diversity and economic needs to make arthroplasty affordable globally [23]. Device manufacturers should focus on simpler, novel solutions that prioritize affordability without sacrificing clinical success to make arthroplasty affordable globally [23].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Radiocapitellar prosthetic arthroplasty largely preserves elbow kinematics and stability [30]. Radiocapitellar arthroplasty can restore normal elbow kinematics with the medial collateral ligament (MCL) intact [44]. The motion pattern after total elbow replacement is less constrained than in the normal elbow, particularly in unlinked prostheses [53]. Recent changes in elbow arthroplasty device design and implantation methods are driven by biomechanical and clinical outcome-based research to better reproduce elbow kinematics, resulting in more durable and long-lasting joint replacement procedures [32].

Elbow joint loads during simulated activities of daily living involve analysis of elbow joint moments in different directions [31]. The kinematics of the elbow deviate increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius [33]. Placement of a distal humeral hemiarthroplasty implant causes a small but significant alteration in elbow joint kinematics, regardless of implant size [39]. Overstuffing the radial head prosthesis alters joint kinematics and may lead to pain and degenerative changes [60].

Radial Head Prosthetics

From a biomechanical perspective, the enhancement of elbow stability with a monopolar radial head prosthesis is superior to that with a bipolar design [41]. The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure, but different patterns of contact pressure and area curves during elbow flexion-extension were observed [64]. A nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions, but there are also orientations where contact area is reduced and stress is increased [52].

Total Elbow Arthroplasty (TEA) and Revision

Cementing a nonanatomic hinge that may not rely on the native elbow soft tissue support can result in a troubling biomechanical environment [46]. The most common mode of failure requiring revision of total elbow arthroplasty is aseptic loosening, which may be a consequence of the known biomechanical challenges inherent to elbow arthroplasty [48]. Improvement of range of motion (ROM) of the elbow should not be expected after revision elbow arthroplasty using the Latitude total elbow arthroplasty [49]. Function of the elbow may compare unfavourably to that after an uncomplicated total elbow arthroplasty (TEA) in cases of infection with stable components [55].

Implant Design and Alignment

Because of the variable ulnar anatomy, modular or custom designs may be needed to achieve accurate alignment with the ulnar flexion axis and central positioning of the stem [62]. The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction [63]. Both hemiarthroplasty and total elbow arthroplasty provided acceptable elbow function for irreparable distal humeral fractures [57].

Alternative Reconstruction and Instability

The Internal Joint Stabilizer of the Elbow (IJS-E) is a good option for use in patients with traumatic elbow instability, as it restores motion and function without immediate postoperative complication [59]. Radius neck–to–humerus trochlea transposition for elbow reconstruction after resection of the proximal ulna results in useful elbow motion in the sagittal plane by means of a biologic reconstruction while avoiding complications of allograft and prosthetic reconstruction [61].

Classification

Periprosthetic Joint Infection (PJI): New evidence-based and validated criteria for PJI offer high specificity (99.5%) and higher sensitivity (97.7%) compared with prior MSIS definitions [17]. A topographic principle is proposed for PJI classification, suggesting that identifying the exact location of bacterial colonization (e.g., joint space vs. bone-prosthetic interface) can guide treatment strategy, potentially allowing implant retention in cases where the interface is not invaded and necessitating radical intervention otherwise [43].

Other Considerations: Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1]. Total elbow arthroplasty in patients with rheumatoid arthritis is associated with substantially higher implant failure and complication rates compared with hip and knee arthroplasties [24]. Limited evidence suggests no significant difference in clinical outcomes among the different subtypes of articulating spacers [26]. The type of prosthesis (cemented versus uncemented) or coating with hydroxyapatite does not influence the incidence of surgical site infection or periprosthetic joint infection [68].

Radial Head Arthroplasty: Heterogeneity in implant type, patient characteristics, and outcome measures, along with inadequate reporting of study details, restricts definitive conclusions regarding functional outcomes post-radial head arthroplasty [8]. Differences exist across different fixed-stem radial head implants in revision rates, certain complications, and functional scores [9].

Total Elbow Arthroplasty (TEA): Long-term surveillance of primary linked total elbow arthroplasty identifies all failing implants requiring revision, with none identified via patient-initiated review [3]. No implant-related complications of the linked convertible total elbow arthroplasty system were encountered in the management of distal humeral fractures in the elderly, though longer-term follow-up is needed [20]. Modification of total elbow arthroplasty implants is not uncommon, particularly in revision arthroplasty [58].

Hip Arthroplasty: A deep-learning system using AP plain radiographs accurately differentiated among 18 hip arthroplasty models from four industry-leading manufacturers [65]. Further validation and replication of results away from designer sites are needed to ensure robust generalizability of artificial intelligence and robotics in joint arthroplasty [66].

Manufacturing and Design: Additive manufacturing for metal applications in orthopaedic surgery offers improved biomechanical properties and fixation systems, enabling use in areas where current implants are not well suited [69]. Device manufacturers must design arthroplasty devices that are usable and affordable in emerging markets by addressing regional anatomic diversity and economic needs, focusing on simpler, novel solutions that prioritize affordability without sacrificing clinical success [23].

Clinical Presentation

History: Patients with bleeding disorders undergoing revision arthroplasty report good clinical outcomes at medium-term follow-up [1]. In trapeziometacarpal joint surface replacement, outcomes improve significantly in the short-term and remain excellent long-term for stable implants, but deteriorate clearly in cases of loosening [2]. For total elbow arthroplasty (TEA), trauma as an indication appears to increase complication rates compared to inflammatory arthropathy [4]. Revision TEA without implant removal yields good functional and subjective long-term results in patients with hemophilia [5].

Inspection and Palpation: In primary unconstrained total shoulder arthroplasty, pain relief is good or excellent in 82% of shoulders [13]. Radiographic loosening is more common than clinically suspected in this population [13]. For radial head prostheses, xerograms confirm fracture diagnosis and localize fragment positions within the joint [16].

Range-of-Motion and Stability: Long-term surveillance of primary linked TEA identifies all failing implants requiring revision, yet none were identified via patient-initiated review [3]. Dissociated Coonrad–Morrey implant revisions require closely long-term follow-up to monitor for asymptomatic osteolysis or polyethylene wear to prevent extensive revision surgery [6]. The Devas elbow replacement prosthesis demonstrated minimal wear after 31 years, allowing the patient to function virtually pain-free [11]. Conversely, early radiologic loosening of the radial component in primary TEA with the Latitude implant is a concern, though it has not yet resulted in clinical symptoms or implant failure [12].

Special Tests and Diagnostic Criteria: New evidence-based criteria for periprosthetic joint infection (PJI) offer high specificity (99.5%) and higher sensitivity (97.7%) compared with prior MSIS definitions [17]. Specific diagnostic thresholds for acute and chronic PJI are defined, recommending a diagnostic algorithm incorporating serology and joint aspiration [36]. The International Consensus on PJI reached agreement on all but four of 207 questions regarding prevention, diagnosis, and treatment [34]. Candida infection after prosthetic arthroplasty is a rare complication often misdiagnosed initially; antibiotic therapy alone may fail to eradicate Candida arthritis in the presence of an implant, requiring implant removal [38].

Red-Flag Patterns: Heterogeneity of implant type, patient characteristics, and outcome measures, along with inadequate reporting of study details, restrict definitive conclusions regarding functional outcomes post-radial head arthroplasty [8]. Differences across different fixed-stem radial head implants exist in revision rates, certain complications, and functional scores [9]. Continued advances in exposure, implant design, and complication management are key to making elbow arthroplasty as reliable and lasting as hip or knee arthroplasty [7]. Polyethylene wear testing of a nonmechanically linked total elbow replacement demonstrated less wear than other joint replacements [35].

Investigations

Plain radiography: Primary linked total elbow arthroplasty: Long-term surveillance identifies all failing implants requiring revision [3]. Patient-initiated review fails to identify failing implants [3]. Trauma as an indication for total elbow arthroplasty is associated with increased complication rates compared to inflammatory arthropathy [4]. For Coonrad–Morrey implants, closely long-term follow-up is necessary to monitor for asymptomatic osteolysis or polyethylene wear to prevent extensive revision surgery [6]. Early radiologic loosening of the radial component in Latitude primary total elbow replacement is a concern, though it has not yet resulted in clinical symptoms or implant failure [12].

Total shoulder arthroplasty (TSA): Pain relief was good or excellent in 82 per cent of shoulders in unconstrained TSA [13]. Radiographic loosening was more common than clinically suspected in unconstrained TSA [13]. In comparisons of eccentric reaming versus posterior augment for posterior glenoid wear, five patients in the TSA group had radiographic evidence of glenoid loosening, whereas no patients in the reverse total shoulder arthroplasty (RSA) group demonstrated prosthetic loosening [71].

Total wrist arthroplasty: Periprosthetic radiolucency is a progressive phenomenon originating at the bone adjacent to the joint line [27]. This radiolucency may be due to stress shielding [27].

Radial head arthroplasty: Metal radial head prostheses can cause early progressive erosion of the capitellum in patients with osteopenic bone [79]. The radiographic appearance of the subchondral bone of the capitellum should be considered when delayed implantation of a radial head prosthesis is planned [79]. The radial head arthroplasty diameter can be predicted preoperatively in two-thirds of cases from a simple measurement of the humeral condyle diameter with an appropriate lateral view of a simple radiograph [78].

Silastic radial-head prosthesis: Xerograms confirmed the diagnosis of a fracture and helped localize the positions of the fragments within the joint [16].

Acetabular components: Separation of the first and second-generation Harris Galante acetabular component may be subtle and not detected on radiographs [75]. In the presence of osteolysis, this separation can lead to extensive metalosis and component failure [75].

Other Considerations: Revision arthroplasty in bleeding disorders: Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1].

Trapeziometacarpal joint prostheses: Clinical outcomes for surface replacement trapeziometacarpal joint prostheses improved significantly in the short-term and remained excellent in the long-term in patients with stable implants [2]. Outcomes deteriorated clearly in cases of loosening [2].

Hydroxyapatite-coated femoral implants: Early clinical and radiographic findings are encouraging, with pain ratings and Harris hip-scores comparable to or superior to cemented and porous press-fit prostheses [74].

Modular dual-mobility implants: In vivo corrosion was observed in a retrieval study [80]. These implants should be used judiciously until larger series with clinical correlation can be completed [80].

Arthroscopic ulnohumeral arthroplasty: The long-term durability regarding preservation of ROM and radiographic progression of arthritis remains unknown [83].

Treatment

Non-Operative

Routine prophylactic antibiotics prior to invasive dental, gastrointestinal, or genitourinary procedures are not advocated in patients who have joint arthroplasty [45].

Operative

Indications: Acute trauma is the most common indication for radial head arthroplasties [19]. Elbow interposition arthroplasty is a salvage procedure best indicated for severe posttraumatic elbow arthritis or rheumatoid arthritis in young, high-demand patients with near-normal bone anatomy [54]. Unicompartmental and bicompartmental arthroplasty of the knee with a finned metal tibial-plateau implant has a place in reconstructive surgery of the arthritic knee joint with proper indications [18]. In nearly 95% of knees for which total arthroplasty is indicated, a non-constrained cruciate-preserving prosthesis can provide adequate relief of pain, satisfactory axial alignment of the limb, and stability [76].

Surgical Approach / Technique: Polyethylene bearing exchange for the Discovery Elbow System provides successful and reproducible surgical techniques with expected clinical outcomes [25]. Limited evidence suggests no significant difference in clinical outcomes among the different subtypes of articulating spacers [26]. Articulating spacers provide better function than non-articulating spacers for patients between stages of two-stage exchange arthroplasty, especially for those with spacers in place longer than 3 months [85]. Novel and futuristic approaches to disrupt or inhibit biofilm formation are being discussed for the management of periprosthetic infections [77].

Implant Selection: The Radial Head System is the most commonly used implant for radial head arthroplasties [19]. The Nexel total elbow arthroplasty demonstrated excellent overall survivorship and a low rate of implant loosening at midterm follow-up [14]. The Acclaim Prosthesis is an effective revision prosthesis for total elbow replacement based on medium-term results [15]. Individualized megaimplants in acetabular revision arthroplasty are associated with increased implant survivorship, lower re-revision rates, and improved functional outcomes [21]. A hinged silicone prosthesis for replacement arthroplasty of the first metatarsophalangeal joint should be used with caution as it lacks durability and reliability [56].

Alignment / Balancing Strategy: Total elbow arthroplasty obtained good results in terms of prosthesis survival, although results were worse than for knee and hip arthroplasties [50]. Total elbow arthroplasty obtained fairly good results in terms of prosthesis survival, although results were poorer than for knee and hip arthroplasties [51].

Pain Management: [No specific evidence provided in source bullets.]

Adjuncts: [No specific evidence provided in source bullets.]

Revision: Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1]. Revision total elbow arthroplasty without implant removal provides good functional and subjective long-term results in patients with hemophilia [5].

Other Considerations: Clinical outcomes for surface replacement trapeziometacarpal joint prostheses improved significantly in the short-term and remained excellent in the long-term for patients with stable implants [2]. Clinical outcomes for surface replacement trapeziometacarpal joint prostheses deteriorated clearly in cases of implant loosening [2]. Trauma as an indication for total elbow arthroplasty appears to have increased complication rates compared to inflammatory arthropathy [4]. Closely long-term follow-up is necessary to monitor for asymptomatic osteolysis or polyethylene wear in total elbow arthroplasty to prevent extensive revision surgery [6]. Most patients with juvenile idiopathic arthritis benefit from total elbow arthroplasty for a long term with satisfactory clinical outcomes and implant durability [10]. Total elbow arthroplasty provides acceptable outcomes in terms of function and implant survival for non-rheumatoid patients with a fracture of the distal humerus who survive the procedure [22]. Unlinked, noncongruous elbow arthroplasty can be a successful alternative in the management of acute distal humeral fractures when internal fixation is not a viable option [70]. Lateral resurfacing elbow arthroplasty is a satisfactory alternative to total elbow arthroplasty with lower rates of complications and does not require activities to be restricted to the same extent [81]. Radial head replacement for acute unreconstructable fractures of the radial head in unstable elbow injuries has a high risk of reoperation, with the peak risk appearing within 1 year after implantation [82]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [67].

Complications

Aseptic loosening: Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1]. Clinical outcomes for surface replacement trapeziometacarpal joint prostheses remain excellent in the long-term for patients with stable implants but deteriorate clearly in cases of loosening [2]. It is safe to perform single-stage revision arthroplasty for presumed aseptic loosening based on history, examination, normal inflammatory markers, and negative aspiration results without the need for open biopsy [72].

Implant failure and wear: Long-term surveillance of primary linked total elbow arthroplasty identifies all failing implants requiring revision, whereas none were identified via patient-initiated review [3]. Periprosthetic radiolucency in total wrist arthroplasty is a progressive phenomenon that originates at the bone adjacent to the joint line, possibly due to stress shielding [27]. The calculated probability of polycentric total knee arthroplasty remaining successful ten years postoperatively was 66 percent [29]. Patients undergoing isolated Coonrad-Morrey bushing exchanges may experience relatively high revision and complication rates, but more than half retain their bushings and implants at long-term follow-up with good clinical outcomes [42]. The Devas elbow replacement prosthesis demonstrated minimal wear after 31 years, allowing the patient to function virtually pain-free [11].

Infection and inflammation: Trauma as an indication for total elbow arthroplasty is associated with increased complication rates compared to inflammatory arthropathy [4].

Other Considerations: Surgeons must be aware of differing complications related to their specific implant of choice, as each implant has its own specific complications [4]. Revision total elbow arthroplasty without implant removal provides good functional and subjective long-term results [5]. Continued advances in exposure, implant design, and complication management are key to making elbow arthroplasty as reliable and lasting as hip or knee arthroplasty [7]. Patients with juvenile idiopathic arthritis benefit from total elbow arthroplasty with satisfactory clinical outcomes and implant durability for the long term [10]. The Nexel total elbow arthroplasty demonstrated excellent overall survivorship and a low rate of implant loosening at midterm follow-up [14]. The Acclaim prosthesis is an effective revision prosthesis based on medium-term results [15]. No implant-related complications of the convertible total elbow arthroplasty system were encountered in the management of distal humeral fractures in the elderly, though longer-term follow-up is needed [20]. Ninety-two percent of patients who had primary arthroplasty and 81 percent of those who had surgical revision using the kinematic stabilizer prosthesis had a good or excellent result [28]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, bipolar radial head arthroplasty using Judet's prosthesis achieved mainly good clinical results [73].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity or return to desk work.

Full activity (months): Evidence does not specify a month range for full activity or manual work.

Complete recovery / outcome plateau (months): Evidence does not specify a month range for complete recovery or outcome plateau.

Rehabilitation protocol: Evidence does not specify rehabilitation protocols, immobilisation duration, or weight-bearing progression.

Functional milestones: Revision arthroplasty in patients with bleeding disorders yields good clinical outcomes at medium-term follow-up [1]. Clinical outcomes for surface replacement trapeziometacarpal joint prostheses improved significantly in the short-term and remained excellent in the long-term for patients with stable implants [2]. Clinical outcomes for surface replacement trapeziometacarpal joint prostheses deteriorated clearly in cases of loosening [2]. Revision without implant removal provides good functional and subjective long-term results in patients with hemophilia [5]. Most juvenile idiopathic arthritis patients benefit from total elbow arthroplasty for a long term with satisfactory clinical outcomes and implant durability [10]. The Devas elbow replacement prosthesis demonstrated minimal wear after 31 years, allowing the patient to function virtually pain-free [11]. Pain relief was good or excellent in 82 per cent of shoulders following unconstrained total shoulder arthroplasty [13]. The Nexel total elbow arthroplasty demonstrated excellent overall survivorship and a low rate of implant loosening at midterm follow-up [14]. Medium-term results suggest the Acclaim prosthesis is an effective revision prosthesis for total elbow replacement [15]. Individualized megaimplants in acetabular revision arthroplasty are associated with increased implant survivorship, lower re-revision rates, and improved functional outcomes [21]. Total elbow arthroplasty provides acceptable outcomes in terms of function and implant survival for non-rheumatoid patients with a fracture of the distal humerus who survive the procedure [22]. Ninety-two per cent of patients who had primary arthroplasty using the kinematic stabilizer prosthesis had a good or excellent result [28]. Eighty-one per cent of patients who had surgical revision using the kinematic stabilizer prosthesis had a good or excellent result [28]. The long-term survival rate of single-mobility uncemented prostheses in trapeziometacarpal osteoarthritis is satisfactory, with a critical period in the first years ranging from 83% after 5 years to 50% after 30 years [47]. Kaplan–Meier survivorship with revision for aseptic loosening as the endpoint for the Exeter Contemporary flanged cemented acetabular component was 100% at 12.5 years [88]. Kaplan–Meier survivorship for all causes for the Exeter Contemporary flanged cemented acetabular component was 97.8% [88].

Other Considerations: Long-term surveillance of primary linked total elbow arthroplasty identified all failing implants requiring revision [3]. None of the failing implants requiring revision in primary linked total elbow arthroplasty were identified via patient-initiated review [3]. Closely long-term follow-up is necessary to monitor for asymptomatic osteolysis or polyethylene wear to prevent extensive revision surgery in dissociated Coonrad–Morrey implants [6]. There is concern about early radiologic loosening of the radial component in primary total elbow replacement with the Latitude prosthesis, though this has not resulted in clinical symptoms or implant failure yet [12]. Radiographic loosening was more common than clinically suspected in unconstrained total shoulder arthroplasty [13]. The calculated probability of polycentric total knee arthroplasty remaining successful ten years postoperatively was 66 per cent [29]. The salvage cohort for total elbow arthroplasty after distal humerus fracture had an increased risk of revision when compared to the delayed cohort [87].

Key Evidence

  • [L4] Revision arthroplasty in this group of patients yields good clinical outcomes at medium-term follow-up. (10.1016/j.jse.2015.01.004)
  • [L4] However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. (10.1186/s12891-021-03957-8)
  • [L4] Surveillance identified all failing implants requiring revision, with none identified via patient-initiated review. (10.1177/17585732241301356)
  • [L2] Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication, and trauma as an indication appears to have increased complication rates compared to inflammatory arthropathy. (10.1177/1758573220905629)
  • [L4] However, even after revision without implant removal, it provides good functional and subjective long-term results. (10.1016/j.jse.2017.09.009)
  • [Case_report] The authors suggest that closely long-term follow-up is necessary to monitor for asymptomatic osteolysis or polyethylene wear to prevent extensive revision surgery. (10.1016/j.xrrt.2025.04.003)
  • [L5] Continued advances in exposure, implant design, and complication management are key to making elbow arthroplasty as reliable and lasting as hip or knee arthroplasty. (10.1177/1758573216677200)
  • [L4] The heterogeneity of type of implant, patient characteristics and outcome measures used, along with an inadequate reporting of study details, restrict any definitive conclusions being made. (10.1177/1758573214524934)
  • [L1] Differences were seen across different implants in revision rates, certain complications, and functional scores. (10.1016/j.jseint.2019.11.003)
  • [L4] However, most benefit from the intervention for a long term with satisfactory clinical outcomes and implant durability. (10.1016/j.jse.2014.03.012)
  • [L4] The prosthesis demonstrated minimal wear after 31 years, allowing the patient to function virtually pain-free. (10.1111/j.1758-5740.2010.00097.x)
  • [L4] There is concern about early radiologic loosening of the radial component, though this has not resulted in clinical symptoms or implant failure yet. (10.1016/j.jse.2017.06.037)
  • [L4] Pain relief was good or excellent in 82 per cent of shoulders, though radiographic loosening was more common than clinically suspected. (10.2106/00004623-198971090-00003)
  • [L4] At midterm follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. (10.1016/j.jse.2024.02.017)
  • [L4] The medium term results for this implant suggest it is an effective revision prosthesis. (10.1111/j.1758-5740.2009.00020.x)
  • [L5] The new evidence-based and validated criteria for periprosthetic joint infection offer high specificity (99.5%) and higher sensitivity (97.7%) compared with prior MSIS definitions, representing a major step forward in diagnosis and management. (10.1016/j.arth.2018.02.084)
  • [L4] The results suggest that with the proper indications this arthroplasty has a place in reconstructive surgery of the arthritic knee joint. (10.2106/00004623-198567080-00005)
  • [L3] For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. (10.1177/1758573220987843)
  • [L4] No implant-related complications of this convertible implant system were encountered, but longer-term followup is needed. (10.1016/j.jhsa.2020.10.034)
  • [L5] Clinical studies report successful outcomes including increased implant survivorship, lower re-revision rates, and improved functional outcomes. (10.1530/eor-24-0064)
  • [L4] For those that survive, TEA provides acceptable outcomes in terms of function and implant survival. (10.1302/0301-620x.98b3.35508)
  • [L5] To make arthroplasty affordable globally, device manufacturers must design devices that are usable and affordable in emerging markets by addressing regional anatomic diversity and economic needs, focusing on simpler, novel solutions that prioritize affordability without sacrificing clinical success. (10.5435/jaaos-d-15-00350)
  • [L1] However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. (10.1302/0301-620x.102b8.bjj-2019-1465.r1)
  • [L4] This series provides surgeons managing DES arthroplasty with management principles, successful and reproducible surgical techniques and expected clinical outcomes in performing DES polyethylene bearing exchange. (10.5397/cise.2023.00668)
  • [L4] Limited evidence suggests no significant difference in clinical outcomes among the different subtypes of articulating spacers. (10.1186/s42836-023-00167-6)
  • [L4] Periprosthetic radiolucency is a progressive phenomenon that originates at the bone adjacent to the joint line, possibly due to stress shielding. (10.1177/17531934241232059)
  • [L4] Ninety-two per cent of the patients who had had primary arthroplasty and 81 per cent of those who had had surgical revision had a good or excellent result. (10.2106/00004623-198870040-00003)
  • [L3] The calculated probability of the arthroplasty remaining successful ten years postoperatively was 66 per cent. (10.2106/00004623-198466080-00008)
  • [L4] The procedure largely preserves elbow kinematics and stability. (10.1016/j.jse.2014.01.042)
  • [L5] This study analyzed elbow joint moments in different directions during daily tasks. (10.1016/j.jse.2023.07.042)
  • [L5] Recent changes in device design and implantation methods are driven by biomechanical and clinical outcome-based research to better reproduce elbow kinematics, resulting in more durable and long-lasting joint replacement procedures. (10.1302/2058-5241.2.160064)
  • [L5] The kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius. (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
  • [L5] The consensus process successfully reached agreement on all but four of 207 questions regarding the prevention, diagnosis, and treatment of periprosthetic joint infection, providing a comprehensive approach to minimize variations in care and reduce the burden of infection. (10.1302/0301-620x.95b11.33135)
  • [L5] The test demonstrated less wear than other joint replacements, though further clinical evaluation is necessary to determine if this translates into reduced complications. (10.1016/j.jse.2024.07.015)
  • [L5] They also defined specific diagnostic thresholds for acute and chronic PJI and recommended a diagnostic algorithm incorporating serology and joint aspiration. (10.1016/j.arth.2013.09.040)
  • [Case_report] Candida infection after prosthetic arthroplasty is a rare complication often misdiagnosed initially; the implant should be removed when Candida arthritis occurs in the presence of an implant, as antibiotic therapy alone may fail to eradicate the infection. (10.2106/00004623-198668010-00020)
  • [L5] This study showed a small but significant alteration in elbow joint kinematics with placement of a distal humeral hemiarthroplasty implant, regardless of implant size. (10.1016/j.jse.2014.02.011)
  • [L5] From a biomechanical perspective, the enhancement of elbow stability with a monopolar radial head prosthesis is superior to that with a bipolar design. (10.1016/j.jse.2010.10.033)
  • [L4] Patients may experience relatively high revision and complication rates, but more than half retain their bushings and implants at long-term follow-up with good clinical outcomes. (10.1016/j.jse.2025.02.004)
  • [L5] The authors propose introducing a topographic principle into PJI classification, suggesting that identifying the exact location of bacterial colonization (e.g., joint space vs. bone-prosthetic interface) can guide treatment strategy, potentially allowing implant retention in cases where the interface is not invaded and necessitating radical intervention otherwise. (10.1007/s00402-018-3058-y)
  • [L5] Radiocapitellar arthroplasty can restore normal elbow kinematics with the MCL intact. (10.1016/j.jhsa.2012.02.021)
  • [L5] Based on the data presented, we do not advocate for the use of routine prophylactic antibiotics prior to invasive dental, GI, or GU procedures in patients who have joint arthroplasty. (10.1016/j.arth.2025.08.061)
  • [L5] Cementing a nonanatomic hinge that may not rely on the native elbow soft tissue support can result in a troubling biomechanical environment. (10.1016/j.jhsa.2018.11.020)
  • [L4] The long-term survival rate of single-mobility uncemented prostheses is satisfactory, with a critical period in the first years ranging from 83% after 5 years to 50% after 30 years. (10.1177/17531934231221692)
  • [L4] The most common mode of failure requiring revision is aseptic loosening, which may be a consequence of the known biomechanical challenges inherent to elbow arthroplasty. (10.1016/j.jse.2025.05.024)
  • [L4] Improvement of ROM of the elbow should not be expected. (10.1302/0301-620x.98b8.35025)
  • [L2] Good results in terms of prosthesis survival were obtained with total elbow arthroplasty, although results were worse than for knee- and hip arthroplasties. (10.1016/j.jse.2009.02.020)
  • [L2] Fairly good results in terms of prosthesis survival were obtained with TEA, although results were poorer than for knee and hip arthroplasties. (10.1016/j.jse.2017.10.018)
  • [L5] Whereas a nonaxisymmetric radial head can provide improved contact mechanics at certain forearm rotations and flexions, there are also orientations where contact area is reduced and stress is increased. (10.1016/j.jse.2014.12.011)
  • [L4] The motion pattern after total elbow replacement is less constrained than in the normal elbow, particularly in unlinked prostheses. (10.1016/j.jse.2008.03.003)
  • [L5] Interposition arthroplasty is a salvage procedure best indicated for severe posttraumatic elbow arthritis or rheumatoid arthritis in young, high-demand patients with near normal bone anatomy. (10.1016/j.hcl.2011.01.002)
  • [L4] Function of the elbow may compare unfavourably to that after an uncomplicated TEA. (10.1302/0301-620x.98b7.36397)
  • [L4] The authors recommend using this implant with caution as it lacks durability and reliability. (10.2106/00004623-199274080-00022)
  • [L1] Both treatments provided acceptable elbow function. (10.1016/j.jse.2022.01.016)
  • [L4] Modification of TEA implants is not uncommon, particularly in revision arthroplasty. (10.1016/j.jse.2023.02.124)
  • [L4] The IJS-E is a good option for use in patients with traumatic elbow instability, as it restores motion and function without immediate postoperative complication. (10.1016/j.jse.2019.12.018)
  • [L5] Overstuffing the radial head prosthesis alters joint kinematics and may lead to pain and degenerative changes. (10.1177/1758573219881772)
  • [L4] The procedure results in useful elbow motion in the sagittal plane by means of a biologic reconstruction while avoiding complications of allograft and prosthetic reconstruction. (10.1016/j.jhsa.2008.04.004)
  • [L5] Because of the variable ulnar anatomy, modular or custom designs may be needed to achieve accurate alignment with the ulnar flexion axis and central positioning of the stem. (10.1016/j.jse.2008.03.008)
  • [L4] The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. (10.1016/j.jse.2014.08.013)
  • [L5] The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure; however, different patterns of contact pressure and area curves during elbow flexion-extension were observed. (10.1016/j.jhsa.2018.08.005)
  • [L4] A deep-learning system using AP plain radiographs accurately differentiated among 18 hip arthroplasty models from four industry leading manufacturers. (10.1016/j.arth.2020.11.015)
  • [L5] The special edition brings together novel research on AI and robotics in joint arthroplasty, highlighting the need for further validation and replication of results away from designer sites to ensure robust generalizability. (10.1186/s42836-025-00302-5)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L5] The type of prosthesis (cemented versus uncemented) or coating with hydroxyapatite does not influence the incidence of surgical site infection or periprosthetic joint infection. (10.1016/j.arth.2013.09.039)
  • [L5] This technology offers improved biomechanical properties and fixation systems, enabling use in areas where current implants are not well suited. (10.5435/jaaos-d-19-00420)
  • [L4] Our short-term results demonstrate that unlinked, noncongruous elbow arthroplasty can be a successful alternative in the management of acute distal humeral fractures, when internal fixation is not a viable option. (10.1016/j.jse.2007.06.011)
  • [L3] Five patients in the TSA group had radiographic evidence of glenoid loosening, while no patients in the RSA group demonstrated prosthetic loosening. (10.1016/j.jse.2014.11.014)
  • [L4] Given the results of this study, we conclude that is safe to perform single-stage revision arthroplasty for implant loosening based on history, examination, normal inflammatory markers, and negative aspiration results without the need for open biopsy. (10.1016/j.jse.2020.05.017)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] The early clinical and radiographic findings are encouraging, with pain ratings and Harris hip-scores comparable to or superior to cemented and porous press-fit prostheses. (10.2106/00004623-199307000-00018)
  • [L4] The separation may be subtle and not detected on radiographs, and in the presence of osteolysis, it can lead to extensive metalosis and component failure. (10.1016/j.arth.2006.05.027)
  • [L4] Based on the findings in this study, in nearly 95 per cent of knees for which total arthroplasty is indicated a non-constrained cruciate-preserving prosthesis can provide adequate relief of pain, satisfactory axial alignment of the limb, and stability. (10.2106/00004623-198365070-00005)
  • [L4] The review discusses current and emerging treatment strategies to reduce the incidence of periprosthetic joint infection and reports on novel and futuristic approaches to disrupt or inhibit biofilm formation. (10.1302/0301-620x.97b9.35295)
  • [L4] The radial head arthroplasty diameter can be predicted preoperatively in two-thirds of cases from a simple measurement of the humeral condyle diameter with an appropriate lateral view of a simple radiograph. (10.1016/j.jse.2018.01.017)
  • [L4] The radiographic appearance of the subchondral bone of the capitellum should be considered when a delayed implantation of a radial head prosthesis is planned, as metal prostheses can cause early progressive erosion of the capitellum in patients with osteopenic bone. (10.2106/00004623-200405000-00028)
  • [L4] These implants should be used judiciously until larger series with clinical correlation can be completed. (10.1016/j.arth.2020.05.075)
  • [L4] It is a satisfactory alternative to total elbow arthroplasty with lower rates of complications and does not require activities to be restricted to the same extent. (10.1302/0301-620x.100b3.bjj-2017-0865.r1)
  • [L4] The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation, with the peak risk appearing within 1 year after implantation. (10.1097/corr.0000000000000876)
  • [L4] The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown. (10.1016/j.jse.2006.09.001)
  • [L2] Articulating spacers provide better function than non-articulating spacers for patients between stages of two-stage exchange arthroplasty, especially for those with spacers in place longer than 3 months. (10.1016/j.arth.2013.09.042)
  • [L3] The salvage cohort also had an increased risk of revision when compared to the delayed cohort. (10.1016/j.jse.2024.05.010)
  • [L3] Kaplan–Meier survivorship with revision for aseptic loosening as the endpoint was 100% at 12.5 years and for all causes was 97.8%. (10.1302/0301-620x.98b3.35901)

See Also

References

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2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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