Revision Total Elbow Arthroplasty: Complications and Results

  • Raul Barco


In this chapter, we address the current results of revision arthroplasty, its complications, and some of the challenges for the future. Causes for revision include loosening, infection, instability, and component failure. In a recent systematic review addressing the outcomes of revision TEA, the results were better for the linked implant as shown by the Mayo Elbow Performance Score (MEPS), extension deficit, arc of flexion-extension, and pronation. Complications were reported at a similar rate (46% for the linked design against 45% for the unlinked one). However, linked prostheses had more reoperations than unlinked implants (26% vs. 20%), the indications being similar. Forty-four percent (44%) of patients suffered at least one complication, the most frequent ones in the order of importance being aseptic loosening (22%), transient nerve symptoms (21%), and periprosthetic fracture (15%). There were 128 reoperations in 116 cases (21.8%) consisting in a second revision in 57% of the cases, followed by a second revision with bone grafting (8%), removal of the prosthesis (22%), cerclage wiring (4%), a cement spacer replacement (4%), and debridement with antibiotics (4%).


Elbow Revision arthroplasty Complications Results 


  1. 1.
    Klug A, Gramlich Y, Buckup J, Schweigkofler U, Hoffmann R, Schmidt-Horlohe K. Trends in total elbow arthroplasty: a nationwide analysis in Germany from 2005 to 2014. Int Orthop. 2018;42:883–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Perretta D, van Leeuwen WF, Dyer G, Ring D, Chen N. Risk factors for reoperation after total elbow arthroplasty. J Shoulder Elb Surg. 2017;26:824–9.CrossRefGoogle Scholar
  3. 3.
    Krukhaug Y, Hallan G, Dybvik E, Lie SA, Furnes ON. A survivorship study of 838 total elbow replacements: a report from the Norwegian Arthroplasty Register 1994-2016. J Shoulder Elb Surg. 2018;27:260–9.CrossRefGoogle Scholar
  4. 4.
    Krenek L, Farng E, Zingmond D, SooHoo NF. Complication and revision rates following total elbow arthroplasty. J Hand Surg. 2011;36:68–73.CrossRefGoogle Scholar
  5. 5.
    Lovy AJ, Keswani A, Dowdell J, Koehler S, Kim J, Hausman MR. Outcomes, complications, utilization trends, and risk factors for primary and revision total elbow replacement. J Shoulder Elb Surg. 2016;25:1020–6.CrossRefGoogle Scholar
  6. 6.
    Barco R, Streubel PN, Morrey BF, Sanchez-Sotelo J. Total elbow arthroplasty for distal humeral fractures: a ten-year-minimum follow-up study. J Bone Joint Surg Am. 2017;99:1524–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Sanchez-Sotelo J, O’Driscoll S, Morrey BF. Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation. J Bone Joint Surg Am. 2002;84:1642–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Geurts EJ, Viveen J, van Riet RP, Kodde IF, Eygendaal D. Outcomes after revision total elbow arthroplasty: a systematic review. J Shoulder Elb Surg. 2019;28:381–6.CrossRefGoogle Scholar
  9. 9.
    Sneftrup SB, Jensen SL, Johannsen HV, Søjbjerg JO. Revision of failed total elbow arthroplasty with use of a linked implant. J Bone Joint Surg Br. 2006;88:78–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Shi LL, Zurakowski D, Jones DG, Koris MJ, Thornhill TS. Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Joint Surg Am. 2007;89:1467–75.PubMedGoogle Scholar
  11. 11.
    Malone AA, Sanchez JS, Adams R, Morrey B. Revision of total elbow replacement by exchange cementing. J Bone Joint Surg Br. 2012;94:80–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Day JS, Baxter RM, Ramsey ML, Morrey BF, Connor PM, Kurtz SM, et al. Characterization of wear debris in total elbow arthroplasty. J Shoulder Elb Surg. 2013;22:924–31.CrossRefGoogle Scholar
  13. 13.
    Baghdadi YM, Jacobson JA, Duquin TR, Larson DR, Morrey BF, Sanchez-Sotelo J. The outcome of total elbow arthroplasty in juvenile idiopathic arthritis (juvenile rheumatoid arthritis) patients. J Shoulder Elb Surg. 2014;23:1374–80.CrossRefGoogle Scholar
  14. 14.
    Sanchez-Sotelo J, Baghdadi YM, Morrey BF. Primary linked semiconstrained total elbow arthroplasty for rheumatoid arthritis: a single-institution experience with 461 elbows over three decades. J Bone Joint Surg Am. 2016;98:1741–8.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Griffin JW, Werner BC, Gwathmey FW, Chhabra AB. Obesity is associated with increased postoperative complications after total elbow arthroplasty. J Shoulder Elb Surg. 2015;24:1594–601.CrossRefGoogle Scholar
  16. 16.
    Morrey ME, Hevesi M. The influence of obesity on total elbow arthroplasty. Orthop Clin North Am. 2018;49:361–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Ramirez MA, Cheung EV, Murthi AM. Revision total elbow arthroplasty. J Am Acad Orthop Surg. 2017;25:e166–e74.PubMedCrossRefGoogle Scholar
  18. 18.
    Kho JY, Adams BD, O'Rourke H. Outcome of semi-constrained total elbow arthroplasty in posttraumatic conditions with analysis of bushing wear on stress radiographs. Iowa Orthop J. 2015;35:124–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Wright TW, Hastings H. Total elbow arthroplasty failure due to overuse, C-ring failure, and/or bushing wear. J Shoulder Elb Surg. 2005;14:65–72.CrossRefGoogle Scholar
  20. 20.
    Lee BP, Adams RA, Morrey BF. Polyethylene wear after total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:1080–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Mansat P, Bonnevialle N, Rongières M, Mansat M, Bonnevialle P, French Society for Shoulder and Elbow SOFEC. Results with a minimum of 10 years follow-up of the Coonrad/Morrey total elbow arthroplasty. Orthop Traumatol Surg Res. 2013;99(6 Suppl):S337–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Athwal GS, Morrey BF. Revision total elbow arthroplasty for prosthetic fractures. J Bone Joint Surg Am. 2006;88:2017–26.PubMedCrossRefGoogle Scholar
  23. 23.
    Ehrendorfer S. Elbow revision arthroplasty in the situation of bone loss using an unlinked long-stem prosthesis. J Hand Surg. 1999;24:1337–43.CrossRefGoogle Scholar
  24. 24.
    Loebenberg MI, Adams R, O'Driscoll SW, Morrey BF. Impaction grafting in revision total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:99–106.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhee YG, Cho NS, Parke CS. Impaction grafting in revision total elbow arthroplasty due to aseptic loosening and bone loss. J Bone Joint Surg Am. 2013;95:e741–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Kamineni S, Morrey BF. Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty. J Bone Joint Surg Am. 2004;86:1223–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Moro F. Allograft reconstruction in revision elbow arthroplasty. Der Orthopade. 2017;46:1001–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Foruria AM, Sanchez-Sotelo J, Oh LS, Adams RA, Morrey BF. The surgical treatment of periprosthetic elbow fractures around the ulnar stem following semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2011;93:1399–407.PubMedCrossRefGoogle Scholar
  29. 29.
    Tokunaga D, Hojo T, Ohashi S, Hirata M, Tokumoto Y, Nagashima S, et al. Periprosthetic ulnar fracture after loosening of total elbow arthroplasty treated by two-stage implant revision: a case report. J Shoulder Elb Surg. 2006;15:e23–6.CrossRefGoogle Scholar
  30. 30.
    Amirfeyz R, Stanley D. Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss: a medium-term follow-up. J Bone Joint Surg Br. 2011;93(10):1382–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Morrey ME, Sanchez-Sotelo J, Abdel MP, Morrey BF. Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty. J Bone Joint Surg Am. 2013;95:1117–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Somerson JS, Boylan MR, Hug KT, Naziri Q, Paulino CB, Huang JI. Risk factors associated with periprosthetic joint infection after total elbow arthroplasty. Shoulder Elbow. 2019;11:116–20.PubMedCrossRefGoogle Scholar
  33. 33.
    Kasten MD, Skinner HB. Total elbow arthroplasty. An 18-year experience. Clin Orthop Relat Res. 1993;290:177–88.Google Scholar
  34. 34.
    Aldridge JM 3rd, Lightdale NR, Mallon WJ, Coonrad RW. Total elbow arthroplasty with the Coonrad/Coonrad-Morrey prosthesis. A 10- to 31-year survival analysis. J Bone Joint Surg Br. 2006;88:509–14.PubMedCrossRefGoogle Scholar
  35. 35.
    Morrey BF, Bryan RS. Infection after total elbow arthroplasty. J Bone Joint Surg Am. 1983;65:330–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Wolfe SW, Figgie MP, Inglis AE, Bohn WW, Ranawat CS. Management of infection about total elbow prostheses. J Bone Joint Surg Am. 1990;72:198–212.PubMedCrossRefGoogle Scholar
  37. 37.
    Yamaguchi K, Adams RA, Morrey BF. Infection after total elbow arthroplasty. J Bone Joint Surg Am. 1998;80:481–91.PubMedCrossRefGoogle Scholar
  38. 38.
    Zarkadas PC, Cass B, Throckmorton T, Adams R, Sanchez-Sotelo J, Morrey BF. Long-term outcome of resection arthroplasty for the failed total elbow arthroplasty. J Bone Joint Surg Am. 2010;92:2576–82.PubMedCrossRefGoogle Scholar
  39. 39.
    Streubel PN, Simone JP, Morrey BF, Sanchez-Sotelo J, Morrey ME. Infection in total elbow arthroplasty with stable components: outcomes of a staged surgical protocol with retention of the components. Bone Joint J. 2016;98-B:976–83.PubMedCrossRefGoogle Scholar
  40. 40.
    Peach CA, Nicoletti S, Lawrence TM, Stanley D. Two-stage revision for the treatment of the infected total elbow arthroplasty. Bone Joint J. 2013;95-B:1681–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Spormann C, Achermann Y, Simmen BR, Schwyzer HK, Vogt M, Goldhahn J, et al. Treatment strategies for periprosthetic infections after primary elbow arthroplasty. J Shoulder Elb Surg. 2012;21:992–1000.CrossRefGoogle Scholar
  42. 42.
    Gille J, Ince A, Gonzalez O, Katzer A, Loehr JF. Single-stage revision of peri-prosthetic infection following total elbow replacement. J Bone Joint Surg Br. 2006;88:1341–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Cheung EV, Adams RA, Morrey BF. Reimplantation of a total elbow prosthesis following resection arthroplasty for infection. J Bone Joint Surg Am. 2008;90:589–94.PubMedCrossRefGoogle Scholar
  44. 44.
    Somerson JS, Morrey ME, Sanchez-Sotelo J, Morrey BF. Diagnosis and management of periprosthetic elbow infection. J Bone Joint Surg Am. 2015;97:1962–71.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Raul Barco
    • 1
  1. 1.Upper Limb Unit, Department of Orthopedic Surgery“La Paz” University HospitalMadridSpain

Personalised recommendations