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. 2025 Feb 28;14(5):1645.
doi: 10.3390/jcm14051645.

Analyzing Declining Trends, Patient Demographics, and Complications in Total Elbow Arthroplasty: Nationwide Retrospective Data Analysis

Assil Mahamid  1   2 , Fairoz Jayyusi  1 , Lior Laver  1 , Mohammad Haj Yahya  1 , Gal Wolff  1 , Ali Yassin  1 , Eyal Behrbalk  1
Affiliations

Analyzing Declining Trends, Patient Demographics, and Complications in Total Elbow Arthroplasty: Nationwide Retrospective Data Analysis

Assil Mahamid et al. J Clin Med. .

Abstract

Background: Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods: This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. This study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess associations between patient characteristics and outcomes. Results: A total of 4110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p = 0.012). The cohort had a mean age of 65.99 years, with a predominance of female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were USD 78,473 (IQR: 56,935-115,671 USD). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions: TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of patient optimization, surgical expertise, and postoperative monitoring to improve outcomes.

Keywords: National Inpatient Sample; healthcare utilization; inpatient outcomes; total elbow arthroplasty.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trends in total elbow replacement procedures (2016–2019).
Figure 2
Figure 2
Postoperative complications of patients with total elbow replacement.
See this image and copyright information in PMC

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