TOTAL ELBOW ARTHROPLASTY Outcomes Driving the Evolution of Implant Design

Since the 1940s, innovations in total elbow arthroplasty (TEA) implant design have been made based on reported outcomes. However, complications still exist and current designs remain imperfect. Currently, linked (semiconstrained) implants can be used for any indication for TEA; however, aseptic loosening at the bone-cement interface remains a concern. Unlinked (unconstrained) prostheses have been used primarily in patients with rheumatoid arthritis and in situations where the soft-tissue envelope is intact; however, dislocation and/or instability can occur. Convertible prostheses may provide a solution when the stability of the elbow can be determined intraoperatively, and a semiconstrained implant can be used if the soft-tissue envelope is not intact. Recent long-term results are promising. There are 3 questions that we sought to answer in this review: (1) How did the failures of early implants change the evolution of TEA designs? (2) How did the evolution of implant design change the indications for TEA? (3) How do the results after TEA differ depending on the indications?