Postoperative management of total elbow arthroplasty: Results of a European survey among orthopedic surgeons

Abstract

Background: The number of complications after total elbow arthroplasty (TEA) is high and survival rates are low compared to hip and knee arthroplasties. The most common reason for revision is aseptic loosening, which might be caused by overloading of the elbow. In an attempt to lower failure rates, current clinical practice is to restrict activities for patients with a TEA. However, postoperative management of TEA is a poorly investigated topic, as no evidence-based clinical guidelines exist and the aftercare is often surgeon-based. In this study we evaluated the current postoperative management of TEA among orthopedic surgeons.

Methods: An online survey of 30 questions was sent to 635 members of the European Society for Surgery of the Shoulder and the Elbow (SECEC/ESSSE), about 10% (n = ± 64) of whom are considered dedicated elbow specialists. The questions were on characteristics of the surgeon and on the surgeon's preferred postoperative management, including items to be assessed on length of immobilization, amount of weight bearing and axial loading, instructions on lifelong activities, physiotherapy, and postoperative evaluation of the elbow.

Results: The survey was completed by 54 dedicated elbow specialists from 17 different countries. Postoperative immobilization of the elbow was advised by half of respondents when using the triceps-sparing approach (52%), and even more with the triceps-detaching approach (65%). Postoperative passive movement of the elbow was allowed in the triceps-sparing approach (91%) and in the triceps-detaching approach (87%). Most respondents gave recommendations on weight bearing (91%) or axial loading (76%) by the affected elbow, but the specification shows significant variation.

Conclusion: The results from this survey demonstrate a wide variation in postoperative care of TEA. The lack of consensus in combination with low survival rates stresses the need for clinical guidelines. Further research should focus on creating these guidelines to improve follow-up care for TEA.

Fig 1. Recommended postoperative immobilization of the elbow by respondents, specified per surgical approach (n = 54).

Two respondents gave recommendations on two different approaches, while 52 respondents described just one approach, adding up to 56 answers.

Fig 2. Recommended position of immobilization of the elbow (n = 32).

Fig 3. Passive movement of the elbow allowed postoperatively by respondents, specified per surgical approach.

Two respondents gave recommendations on two different approaches while 52 respondents described just one approach, adding up to 56 answers.

Fig 4. Active movement of the elbow allowed postoperatively by respondents, specified per surgical approach (n = 54).

Two respondents gave recommendations on two different approaches while 52 respondents described just one approach, adding up to 56 answers.

Fig 5. Postoperative advice on elbow weight bearing and axial loading.

5a: Advice on weight bearing by the elbow (n = 49). 5b: Advice on axial loading of the elbow (n = 41).

Fig 6. Moments of postoperative assessment of the elbow.

Percentage is the number of responding orthopedic surgeons (n = 54) performing postoperative assessment of the elbow at any time. Multiple moments may be filled out per respondent.