LONG-TERM OUTCOMES OF PRIMARY TOTAL ELBOW ARTHROPLASTY IN SCOTLAND: A SCOTTISH ARTHROPLASTY PROJECT ANALYSIS OF 1,162 ARTHROPLASTIES

Abstract

Total elbow arthroplasty (TEA) is an established treatment for inflammatory arthropathy, osteoarthritis and trauma sequelae, but concerns remain regarding longevity and revision risk. This study evaluated revision-free survival, cumulative revision incidence accounting for death, and factors associated with failure. Primary TEAs recorded in the Scottish Arthroplasty Project from 1 January 2001 to 31 December 2023 were linked to hospital admissions, procedures and mortality. Implant type was confirmed using clinical portal records and PACS imaging. Failure was defined as first revision or removal. Revision-free survivorship was estimated using Kaplan-Meier methods, cumulative revision incidence using competing-risks analysis, and risk factors using multivariable cause-specific Cox and Fine-Gray models. Of 1491 TEA procedures, 1162 primary TEAs were included. Median age was 67 years (interquartile range 58 to 75), and 891 patients (76.7%) were female. The commonest implants were Coonrad/Morrey (n = 551), Discovery Elbow System (n = 271) and Souter-Strathclyde (n = 154). Overall revision-free survivorship was 87.2% (95% CI 84.3 to 90.1) at 15 years. Fifteen-year survivorship differed by implant: Coonrad/Morrey 88.6% (95% CI 83.8 to 92.1), Discovery 94.7% (95% CI 88.2 to 97.7) and Souter-Strathclyde 78.4% (95% CI 69.8 to 84.8) (log-rank p = 0.0017). Increasing age reduced revision risk (adjusted hazard ratio (aHR) 0.98 per year, 95% CI 0.96 to 0.996; p = 0.018), while Souter-Strathclyde had higher revision risk than Coonrad/Morrey (aHR 2.10, 95% CI 1.21 to 3.64; p = 0.008). Primary TEA showed good long-term survival in Scotland. Younger age and implant type were associated with revision risk, supporting careful selection and counselling.