Optimizing Outcomes in Total Elbow Arthroplasty

The use of total elbow arthroplasty (TEA) is projected to increase by more than 50% between 2020 and 2045. An aging population, contemporary prosthetic designs, and broadened indications are factors associated with this predicted increase. Although TEA can reliably improve pain and function, overall complication rates remain relatively high compared with other arthroplasties, making technical competence of utmost importance. Careful patient selection, preoperative optimization, and thorough counselling on the complication profile and the potential for mechanical failure following TEA are essential. Although debated, surgical exposure to perform TEA should be tailored to the underlying diagnosis and elbow features. Contemporary exposures, including the paraolecranon and the "diamond pop-up," have been popularized only recently. Understanding the nuances of adequate implant positioning, soft-tissue balancing, and good cementation technique can decrease implant interface stresses, impingement, and rotational instability, which have a direct effect on subsequent mechanical failure. The continued success of TEA will depend on advances in surgical planning and technique as well as implant design and materials to improve longevity and allow use with minimal restrictions.