Prognostic factors associated with failure of total elbow replacement: Analysis of National Joint Registry data

Abstract
Aims:
To evaluate potential prognostic factors associated with Total elbow replacement (TER) failure requiring revision surgery.

Methods:
This is a cohort study using data from the National Joint Registry linked to Hospital Episode Statistics Admitted Patient Care and mortality datasets. Adults undergoing primary TER in England between April 2012 and December 2023 were included. Candidate prognostic factors were informed by a systematic review, patient involvement, and a healthcare professional survey. The primary outcome was TER failure, defined as the need for revision surgery. Associations were estimated using multivariable flexible parametric regression models adjusted for age, sex, and surgical indication and reported as hazard ratios (HRs) with 95% confidence intervals (CI)s.

Results:
A total of 4,073 patients underwent primary TER. Mean age was 70 years (SD 12.0), and 3,010 (74%) were female. The cumulative incidence of failure at one-year after TER was 1%, five-years 7% and ten-years 11%. Multivariable analysis found several patient factors to be associated with TER failure. Male sex (HR=1.52;95%CI=1.19-1.95) versus female, and TER performed for trauma sequelae (HR=2.05;95%CI=1.45-2.90) or osteoarthritis (HR=1.64;95%CI=1.21-2.23) versus TER for inflammatory arthritis. Patients in the least deprived socio-economic quintile had a lower hazard of revision surgery (HR=0.66, 95%CI=0.45-0.97) versus patients in the most deprived quintile. Older age was associated with a lower hazard of failure (HR=0.98 per increasing year of age ;95%CI=0.97-0.99). Other factors associated with failure included intra-operative fracture complications (HR=2.00;95%CI=1.27-3.16), and the use of the Latitude Legacy implant (HR=1.98 versus Coonrad Morrey ;95%CI=1.29-3.04) but not the Latitude EV.

Conclusion:
This analysis supports findings from previous studies that younger age, male sex, and TER performed for trauma sequelae or osteoarthritis are linked to a higher risk of failure. Additionally, it highlights for the first time that intra-operative fractures, socio-economic deprivation, and the Latitude Legacy implant are also associated with an increased likelihood of TER failure.