Total elbow arthroplasty in hemophilia: a high-risk surgical procedure

Figures & data

Figure 1. Complications of total elbow arthroplasty (TEA) in the general population [9].

Table 1. Main results of total elbow arthroplasty (TEA) in the general population from 2021 to 2023.

AUTHORS	YEAR	COMPLICATION RATES	REVISION RATES	IMPLANT SURVIVORSHIP RATE
Macken et al. [8]	2021	21%	NA	NA
Davey et al. [9]	2021	16.3%	14.6%	NA
Borton et al. [10]	2021	NA	20.9%	76.8% at 9.9 years
Parker et al. [11]	2021	60.7%	6.3%	NA
Siala et al. [12]	2021	56%	22%	75% at 3.7 years
Meijering et al. [13]	2022	NA	NA	82% at 10 years
Evans et al. [14]	2022	NA	NA	92% at 10-years (linked TEAs), 86% at 10 years (unlinked TEAs).
Nishida et al. [15]	2023	23%	NA	78.1% at 25 years

NA, not available.

Table 2. Total elbow arthroplasty (TEA) in people with hemophilia.

AUTHORS [REFERENCE]	YEAR	TYPE OF STUDY	METHODS	RESULTS	CONCLUSION
Chapman-Sheath et al. [20]	2003	Case series	Seven TEAs in five patients with severe hemophilia A were performed. Mean follow-up: 42 months.	There was an infection. The prosthesis was revised at 2.5 years in a one-stage procedure and showed no evidence of loosening or infection 3 years later.	All the patients had excellent alleviation of pain and improvement in function.
Marshall Brooks et a.l [21]	2011	Case series	Seven TEAs in six patients.	There were no perioperative complications. One patient needed a revision at 2.5 years. At a mean of 10 years postoperatively, five of six patients continued to experience pain relief and preserved functionality. TEA led to favorable outcomes in six of seven procedures.	The findings of this study supported the viability of TEA, especially to diminish pain and preserve or reestablish functionality.
Sorbie et al. [22]	2011	Case series (the population was varied not specifically for hemophilia)	Sorbie-QUESTOR (SQ) unlinked surface arthroplasty performed by a single surgeon over 15 years at a single center.	ROM improved significantly.	Prosthetic survival was 87.5% at 15 years. The patient groups were hemophilia, rheumatoid arthritis, and ‘other,’ which included osteoarthritis, traumatic arthritis, psoriatic arthritis, and reactive arthritis.
Wang et al. [23]	2012	Case series	6 TEAs in 3 patients	According to the MEPS*, outcomes were good to excellent in 83% of patients.	Despite high complication rates TEA was valuable for accomplishing pain alleviation. Patients reported that risks were outweighed by the benefits.
Vochteloo et al. [25]	2015	Case series	Five patients experienced 8 primary TEAs.	Revision TEA was carried out in 3 TEAs. Two revisions were due to aseptic loosening. The third elbow experienced an excision arthroplasty for a deep infection. The mean follow-up for the primary TEAs still in situ was 9.5 years.	Excellent clinical results and an acceptable survival percentage for TEAs, comparable with the nonhemorrhagic population, can be accomplished in patients with bleeding disorders. Revision TEA in this group of patients yielded good clinical results at medium-run follow-up.
Ernstbrunner et al. [4]	2018	Case series	13 primary TEAs (Coonrad-Morrey design) were performed in 9 patients with an average age of 55 years.	After a mean of 9.1 years, the mean VAS score for pain, total MEPS*, and subjective elbow value were substantially improved. There were 8 complications (62%).	TEA was associated with a significant complication and revision rate. However, even after revision without implant removal, it yielded good functional and subjective long-run outcomes.

ROM, range of motion; MEPS, Mayo Elbow Performance Score; VAS, visual analog scale.

*The MEPS measures elbow function across four domains: pain (45 points), stability (10 points), ROM (20 points), and daily functional tasks (25 points). Scores are categorized as 90–100 = excellent, 75–89 = good, 60–74 = fair, 0–59 = poor.

Davey MS, Hurley ET, Gaafar M, et al. Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2021;30(6):1423–1430. doi: 10.1016/j.jse.2020.11.014

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Borton ZM, Prasad G, Konstantopoulos G, et al. Mid- to long-term survivorship of the cemented, semiconstrained discovery total elbow arthroplasty. J Shoulder Elbow Surg. 2021;30(7):1662–1669. doi: 10.1016/j.jse.2020.12.007

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Evans JP, Evans JT, Mohammad HR, et al. How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up. Acta Orthop. 2022;93:495–502. doi: 10.2340/17453674.2022.2753

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Nishida K, Nasu Y, Hashizume K, et al. Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old. Bone Jt Open. 2023;4(1):19–26. doi: 10.1302/2633-1462.41.BJO-2022-0151.R1

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Sorbie C, Saunders G, Carson P, et al. Long-term effectiveness of Sorbie-QUESTOR elbow arthroplasty: single surgeon’s series of 15 years. Orthopedics. 2011;34(9):e561–e569. doi: 10.3928/01477447-20110714-08

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Vochteloo AJ, Roche SJ, Dachs RP, et al. Total elbow arthroplasty in bleeding disorders: an additional series of 8 cases. J Shoulder Elbow Surg. 2015;24(5):773–778. doi: 10.1016/j.jse.2015.01.004

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Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elbow Surg. 2018;27(1):126–132. doi: 10.1016/j.jse.2017.09.009

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