Total Elbow Arthroplasty for Distal Humerus Fractures Outcomes and Complications: A Systematic Review and Meta-Analysis

Objectives Total elbow arthroplasty (TEA) is often utilized for complex distal humerus fractures, particularly in elderly adults. This systematic review and meta-analysis aimed to evaluate the functional outcomes, complication rates, and implant usage trends associated with primary TEA in the modern era. Methods A systematic literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Embase, and Cochrane Library through April 30, 2025. Studies were included if they reported outcomes of primary TEA for acute distal humerus fractures in adult patients aged 18 years and older, with a minimum of five patients per study and at least three months of follow-up. Complications and functional outcomes, including Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand Score (DASH), and range of motion, were pooled by performing random-effects meta-proportion meta-analysis. Study-level heterogeneity and risk of bias were assessed, and publication bias was evaluated, with sensitivity analyses performed to evaluate the robustness of findings. Results Twenty-six studies comprising 904 patients were included. The mean patient age was 73.8 years (range: 64 to 81.3 years), and 88% were female. The most commonly used implant was the Coonrad-Morrey prosthesis (65%). Pooled functional outcomes demonstrated a mean MEPS of 85 and a flexion-extension arc exceeding 100°, while the mean DASH score was 31. The overall complication rate was 23%, with the most frequent complications being heterotopic ossification (28%), infection (17%), and neuropathy (13%). The reoperation or revision rate was 8.2%. Conclusion TEA offers favorable functional outcomes for acute distal humerus fractures in elderly patients but remains associated with high complication and reoperation rates. Surgeons can advise patients of a nearly one-quarter complication rate and a nearly one-tenth reoperation rate. Heterotopic ossification, infection, and neuropathy are the most frequently reported complications, emphasizing the need for prevention, refined surgical techniques, and improved implant characteristics.