Does long-term surveillance of primary linked total elbow arthroplasty identify failing implants requiring revision?

Background: Scoping review has identified a lack of evidence guiding long-term follow-up of elbow arthroplasty. We report the effectiveness of primary linked total elbow arthroplasty surveillance in identifying failing implants requiring revision.

Methods: A prospective database recording consecutive primary linked total elbow arthroplasty and subsequent surveillance in an elbow unit was analysed. Arthroplasties performed between 01.10.2013 and 31.07.2022 were included, with a minimum 1-year follow-up. Surveillance involves specialist physiotherapist review 1, 2, 3, 5, 8 and 10 years postoperatively. Patient-initiated review could occur between time points. Outcome measures include a number of surveillance reviews offered and attended; and the proportion that identified a failing implant requiring revision.

Results: Ninety-seven primary linked total elbow arthroplasties with minimum 1-year follow-up were performed (76 Discovery, 14 Nexel, 7 Coonrad/Morrey). Sixteen patients died prior to 31.07.2023, and three implants required revision <1 year postoperatively. 290 of 328 offered surveillance appointments were attended (88.4%). Five implants required revision ≥1 year post-operatively, with revision requirements identified by surveillance in all cases. Three failures occurred at 5 years postoperatively, and two failures occurred at 8 years postoperatively. Overall, 1.7% attended surveillance appointments identified a failing implant requiring revision.

Discussion: This is the first series reporting the effectiveness of primary linked total elbow arthroplasty surveillance in identifying implants requiring revision.