Indications For Total Elbow Arthroplasty Research Articles

Does timing of total elbow arthroplasty after distal humerus fracture affect 2-year complication rates?

BackgroundOpen reduction internal fixation (ORIF) remains the gold standard for adult distal humerus fractures (DHF). However, indications for total elbow arthroplasty (TEA) continue to expand and the incidence of primary and salvage TEA for DHF has increased. The objective of this study was to compare complication and reoperation rate for acute versus delayed primary and salvage TEA performed for DHF. MethodsPatients who underwent TEA for DHF were identified in the PearlDiver database. Patients were sorted into three cohorts: (1) acute TEA (within 2 weeks of diagnosis), (2) delayed TEA (between 2 weeks and 6 months after diagnosis), and (3) salvage TEA (after failed ORIF, malunion, nonunion, delayed treatment between 6 months-1 year or post-traumatic arthritis). Multivariate analysis was utilized to assess for confounding variables and covariates when identify differences in complications between cohorts. Results788 patients underwent acute TEA, 213 patients underwent delayed TEA, and 422 patients underwent salvage TEA after DHF. The incidence of PJI (8.5% vs. 3.4%, odds ratio (OR) 2.60, P=0.002) and triceps injury (2.4% vs. 0.4%, OR 6.29, P=0.012) were higher in the delayed compared to acute cohort. The incidence of revision (8.5% vs. 2.1%, OR 3.76, P< 0.001), periprosthetic fracture (4.3% vs. 1.1%, OR 3.64, P=0.002), PJI (14.7% vs 3.4%, OR 4.36, P< 0.001), triceps injury (2.6% vs. 0.4%, OR 5.70, P=0.008), and wound complications (6.9% vs 2.9%, OR 2.33, P=0.002) were higher in the salvage compared to acute cohort. There was an increased rate of revision (8.5% vs. 1.9%, OR 6.08, P=0.002) in the salvage compared to delayed cohort. ConclusionPatients undergoing salvage TEA after DHF have increased rates of at 2 years postoperatively including revision, periprosthetic fracture, PJI, triceps injury, and wound complications. The salvage cohort also had an increased risk of revision when compared to the delayed cohort. However, other than revision rates, patients in the salvage and delayed cohorts have similar postoperative complication rates.

Complications of total elbow arthroplasty

The indications for total elbow arthroplasty have been expanded beyond severe arthritis to include acute comminuted fractures. Advances in implant manufacturing and surgical techniques in recent decades have led to increasingly better results. Semiconstrained implants are most commonly used, followed by conversion-type and unlinked implants. However, the results are still worse than those of arthroplasty in the knee or hip joint, and various complications such as aseptic loosening, infection, bushing wear, and periprosthetic fractures still occur. As aging adults are increasingly indicated for surgery, we inevitably face complications that are not easy to control. In this review, we discuss intraoperative and late complications, their prevention, and treatment options.

Comparison of total elbow arthroplasty complications between various surgical indications at 90-day and one-year follow-ups in 1600 elbows.

Total elbow arthroplasty (TEA) was traditionally a mainstay of treatment for patients with severe inflammatory arthritis. Recently, the indications for TEA have expanded and it has grown into a versatile procedure that can be used to treat several pathologies of the elbow. The objective of this study was to compare complication rates between TEA performed for rheumatoid arthritis (RA), fracture (FX), or osteoarthritis (DJD). A retrospective analysis of the MUExtr dataset of the PearlDiver National Database was performed. ICD10 codes were utilized to identify TEA patients from 2010-2020 and separate them into RA, FX, and DJD cohorts. Demographics, comorbidities, and hospital data were identified and compared using ANOVA. Systemic complications at 90 days, as well as surgical complications at 90 days and 1 year were compared using multivariable logistic regression. Surgical complications included wound dehiscence, hematoma, deep infection, periprosthetic fracture, stiffness, instability, triceps injury, nerve injury, and need for revision. 1600 patients (38.9% DJD, 48.8% FX, 12.3% RA) were identified. The majority of patients in all three cohorts were female with the RA group having a significantly higher percentage of female patients compared to DJD and FX (87.3% versus 81.4% and 76.9%, p = 0.003). There were no significant differences noted in systemic complications and surgical complications between all three groups at 90 days postoperative. After controlling for patient factors, FX patients were more likely to develop elbow stiffness (OR 1.53, p=0.006) and less likely to have a triceps injury (OR 0.26, p<0.001) at 1 year than RA or DJD patients. The indications for TEA have expanded over the last ten years with nearly half of all cases being performed for fracture. At one year, those TEAs performed for fracture have a significantly lower rate of triceps injury and higher rate of elbow stiffness postoperatively than when performed for other indications. This is important to consider when preoperatively planning, as well as when discussing expected outcomes with patients prior to surgery, especially with the expanded incidence of TEA for fracture being performed over the last decade.

Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review.

Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called 'high-volume' hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA. A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found. Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.

Factors associated with 30-day complication, reoperation, readmission, and length of stay after primary total elbow arthroplasty: a database study of 555 patients

BackgroundThe indications for total elbow arthroplasty (TEA) have dramatically evolved in recent years, and factors associated with episode-of-care outcomes after TEA are not well-described in contemporary patients. The primary objective of this study was to identify factors associated with 30-day postoperative complication following primary TEA. Secondary objectives of this study were to identify factors associated with reoperation, hospital readmission, and hospital length of stay. MethodsA retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for TEA from 2014 to 2020. The resultant cohort of 555 patients who underwent primary TEA during the study period was included. The primary outcome was a composite variable encompassing all 30-day complication metrics measured by the National Surgical Quality Improvement Program, and secondary outcome variables were reoperation, readmission, and length of stay. A bivariate screen was performed for explanatory variables associated with our outcome variables, and variables with P < .1 in the bivariate screen were included in multivariable regression models. ResultsOf the 555 patients in our cohort, 53 patients (9.5%) developed a complication, 32 patients (5.8%) developed a complication not including blood transfusion, 22 patients (4.0%) underwent reoperation, and 28 patients (5.1%) were readmitted during the 30-day postoperative period. Of the 364 patients who underwent inpatient TEA, median hospital length of stay was 2 days. Multivariable logistic regression analysis showed longer operative time and diabetes mellitus were associated with complication, and lower body mass index was associated with readmission. Male sex was associated with reoperation in the bivariate analysis, and no other variables qualified for inclusion in a multivariable logistic regression model. Multivariable regression analysis showed that higher American Society of Anesthesiologists classification was associated with longer hospital length of stay. ConclusionShort-term postoperative complications following primary TEA are associated with operative time, which may represent surgical difficulty and/or surgeon experience, and diabetes mellitus. Male patients are at higher risk for reoperation, and patients with lower body mass index are at higher risk for hospital readmission. When TEA is performed as an inpatient procedure, length of stay is associated with patient comorbidities. We identified no differences among various indications for TEA in episode-of-care outcomes. Our findings are relevant for preoperative risk stratification and counseling.

Thirty-day readmissions and reoperations after total elbow arthroplasty: a national database study

The purpose of this study was to determine the rate of short-term complications after total elbow arthroplasty (TEA) and identify predictors of readmission and reoperation. We hypothesized that TEA performed for acute elbow trauma would have higher rates of 30-day readmission and reoperation than TEA performed for osteoarthritis (OA). Using the National Surgical Quality Improvement Program for the years 2011-2017, we identified patients undergoing TEA for fracture, OA, or inflammatory arthritis. Patient demographic characteristics, comorbidities, reoperations, and readmissions within 30 days of surgery were analyzed. Potential predictors of reoperation and readmission in the model included age, sex, race, body mass index (BMI), diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, smoking, bleeding disorders, American Society of Anesthesiologists classification, wound classification, operative time, and indication for surgery. A total of 414 patients underwent TEA from 2011-2017. Of these patients, 40.6% underwent TEA for fracture; 37.0%, for OA; and 22.7%, for inflammatory arthritis. The overall rate of unplanned readmissions was 5.1% (21 patients). The rate of unplanned reoperations was 2.4% (10 patients). Infection was the most common reason for both unplanned readmissions and reoperations. The rates of reoperations and readmissions were not significantly associated with any of the 3 operative indications: fracture, OA, or inflammatory arthritis. Multiple logistic regression analysis found increased BMI to be associated with lower odds of an unplanned readmission (odds ratio [OR], 0.883; 95% confidence interval [CI], 0.798-0.963; P = .0035) and found wound classification ≥ 3 to be associated with increased odds of an unplanned reoperation (OR, 16.531; 95% CI, 1.300-167.960; P = .0144) and total local complications (OR, 17.587; 95% CI, 2.207-132.019; P = .0057). Patients who were not functionally independent were more likely to experience local complications (OR, 4.181; 95% CI, 0.983-15.664; P = .0309) than were functionally independent patients. The 30-day unplanned reoperation rate after TEA was 2.4%, and the unplanned readmission rate was 5.1%. Low BMI was predictive of readmission. Wounds classified as contaminated or dirty were predictive of reoperation. Dependent functional status and contaminated wounds were predictive of local complications. The indication for TEA (fracture vs. OA vs. inflammatory arthritis) was not found to be a risk factor for reoperation or readmission after TEA.

An overview and challenges of revision total elbow arthroplasty

Since the introduction of modern total elbow arthroplasty (TEA), there has been a rapid evolution in the understanding of elbow biomechanics, surgical techniques, and improvements in implant materials and design. Aimed originally to treat primarily end-stage rheumatoid arthritis, the indications for TEA have extended to include post-traumatic arthritis, primary osteoarthritis and acute non-reconstructable fractures of the distal humerus. Implant survivorship in TEA is substantially longer in patients with inflammatory arthritis when compared to trauma-related indications. The leading causes of revision are infection, aseptic loosening secondary to polyethylene wear and mechanical failure, and periprosthetic fractures. This article aims to provide an overview on revision TEA and the challenges associated with management of failed primary elbow arthroplasty.

Global trends in indications for total elbow arthroplasty: a systematic review of national registries.

National registries provide useful information in understanding outcomes of surgeries that have late sequelae, especially for rare operations such as total elbow arthroplasty (TEA).A systematic search was performed and data were compiled from the registries to compare total elbow arthroplasty outcomes and evaluate trends. We included six registries from Australia, the Netherlands, New Zealand, Norway, the United Kingdom and Sweden.Inflammatory arthritis was the most common indication for total elbow arthroplasty, followed by acute fracture and osteoarthritis. When comparing 2000–2009 to 2010–2017 data, total elbow arthroplasty for inflammatory arthritis decreased and total elbow arthroplasty for fracture and osteoarthritis increased. There was an increase in the number of revision TEAs over this time period.The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. However, inflammatory arthritis remains the most common indication in recent years. This change is accompanied by an increase in the incidence of revision surgery.Cite this article: EFORT Open Rev 2020;5:215-220. DOI: 10.1302/2058-5241.5.190036

A systematic review of the complications of contemporary total elbow arthroplasty.

Total elbow arthroplasty is a low volume procedure. We aimed to evaluate complication rates and cumulative percentages associated with the most frequently used contemporary implants and for the commonest indications. A systematic literature search of all studies reporting complications following total elbow arthroplasty with 12-month minimum follow-up was undertaken. Quality of studies was assessed with the Methodological-Index-for-Non-Randomised-studies criteria. British NJR data identified the most common UK prostheses and indications. The complication rates for all undesirable events contributing to patient outcome were extracted and cumulative percentages were calculated. One hundred seventeen studies were screened, 12 studies included, totalling 815 procedures. Mean follow-up was 3.8 years. The overall complication cumulative percentage was 60.7%, significantly higher than that seen in other joint arthroplasty, including a 6.5% deep infection rate. Nerve injury was comparable between implants at around 4.1%. Radiographic loosening had a cumulative rate of 17.2%. Revision for symptomatic aseptic loosening was 6.3%. This is the largest systematic review of the complications of total elbow arthroplasty. Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication. Trauma as an indication appears to have an increased complication rates compared to inflammatory arthropathy. There is a lack of literature regarding the independent results of osteoarthritis as a specific indication for total elbow arthroplasty.

Surgical Exposures for Total Elbow Arthroplasty.

Indications for total elbow arthroplasty (TEA) were traditionally reserved for patients with advanced rheumatoid disease and posttraumatic conditions of the elbow. The indications have expanded for TEA to include patients with acute elbow trauma, dysfunctional instability, and end-stage osteoarthritis. Many of these patients are younger and place a greater demand on their TEA. This evolution of TEA use combined with the concern of soft tissue handling and triceps function has led to increased interest regarding surgical exposure for TEA. Three generalized approaches to TEA are predicated on the handling of the triceps tendon: triceps reflecting, triceps splitting, and triceps sparing. Each of these approaches has its own inherent advantages and disadvantages. As indications grow for TEA and the possibility of revision surgery increases with use in younger, higher demand patients, it is important for treating surgeons to use these various exposures so that they are capable of treating patients in a variety of settings.

Decreased early complication rates associated with rheumatoid arthritis compared to alternate indications for total elbow arthroplasty

Abstract: Background Rheumatoid arthritis is currently seen as the primary surgical indication for total elbow arthroplasty (TEA). Nevertheless, surgical indications continue to expand accounting for greater TEA case volumes. Despite evolving trends, very few data describes complications associated with specific surgical indication of TEA. Methods We analyzed The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for individuals that received a TEA from 2006 to 2015. Surgical indications and 30-day postoperative complication data for patients treated as inpatients at participating hospitals was obtained. Results 317 patients were identified for analysis. 22.1% of individuals received TEA for rheumatoid arthritis. 52 total adverse events were reported for all patients undergoing TEA. Rheumatoid arthritis patients experienced significantly lower rates of overall adverse events (8.57% versus 18.62%, p= 0.045). Conclusion Rheumatoid arthritis patients that undergo TEA are significantly less likely to develop a 30 day post-operative complication than patients who receive TEA for other reasons.

Elbow Arthroplasty: From Normal to Failure

Total elbow arthroplasty is currently an established surgical treatment for several pathologies of the elbow. Although initially used primarily in the treatment of rheumatoid arthritis, indications for total elbow arthroplasty have expanded and now include trauma, primary and secondary osteoarthritis, fracture nonunion, and following neoplasm resection. Desired outcomes of elbow arthroplasty include decreasing patient pain, restoration of function and mobility, and prevention of or treatment for instability. In comparison with total elbow arthroplasty, radial head replacements are most commonly performed following trauma. An additional technique, capitellar resurfacing arthroplasty, was developed in an effort to prevent early-onset osteoarthritis secondary to altered elbow biomechanics following radial head replacement. Complications of these surgeries include loosening, fracture, instability and dissociation, bushing wear, and particle disease.

Decreased Early Complication Rates Associated with Rheumatoid Arthritis Compared to Alternate Indications for Total Elbow Arthroplasty

Decreased Early Complication Rates Associated with Rheumatoid Arthritis Compared to Alternate Indications for Total Elbow Arthroplasty

Trends in total elbow arthroplasty: a nationwide analysis in Germany from 2005 to 2014.

To date, there has been no study investigating the epidemiology and the changes over time, especially regarding indications, in total elbow replacement in Germany. Using German procedure classification system (OPS) codes as well as the associated ICD codes, a retrospective analysis from 2005 to 2014 of the data provided by the Federal Statistical Office of Germany was performed. Total elbow arthroplasties (TEAs) were evaluated for admitting diagnoses, sex, and age of patient and distribution of constraint versus unconstraint prostheses. Furthermore, the number and indications of revision elbow arthroplasty (REA) and explantations were identified. From 2005 to 2014, a total of 3872 patients underwent TEA in Germany. This represents a rise of 84% in this period. Almost 77% of the arthroplasties were performed in females, and over 45% were implanted in patients before the age of 70. During the study, a significant increase in TEA performed on patients for trauma from 12 to 42% and concomitantly, a decrease for the arthritis subgroup from 20 to 2.6% could be revealed. Additionally, almost a doubling of REA in that period could be detected (10.3 to 17.1%). The main revision indication could be found in mechanical complications, such as aseptic loosening (72.1%). Conversely, the number of explantations decreased (12.4 to 5.8%). During the study period, the number of TEA performed in Germany nearly doubled. Over the years, the most common indication for total elbow arthroplasty changed from inflammatory arthritis to trauma sequel. Further database analysis may help to identify populations at risk and specify reasons for revisions. Therapeutic Level IV.

A study on clinical outcome of total elbow arthroplasty

Introduction: Prosthetic total elbow arthroplasty (TEA) is a recognised treatment for the painful arthritic elbow. is a challenging procedure for orthopedic surgeons. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The clinical outcome and long-term survivorship differs from implant to implant, and the results obtained with a given linked or unlinked implant cannot be extrapolated to other members of the same implant family.Materials and Methods: 13 cases of total elbow arthroplasty were included in this study, between June 2010 and October 2013. The indications for total elbow arthroplasty in this study were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. Patients with compound fracture around the elbow joint, severely comminuted fracture proximal ulna, flaccid paralysis of the upper limb, non-restorable function of biceps or triceps and patients with high demanding jobs have been excluded from the study. Results: The average operative time was 86.2 minutes (range 64 to 108 minutes). The follow up was from 4 months to 110 months (mean 71 months). The evaluation of the patients was based on clinical as well as on radiological parameters. Pre-operatively four patients had stable elbows as they had ankylosis in non-functional position between 80 to 90° due to rheumatoid arthritis or traumatic arthritis and also stable by virtue of bony fusion. Remaining nine patients had unstable elbows because of fracture distal humerus. Clinico‑radiologically all the elbows were stable. Conclusion: To conclude, a semi constrained total elbow arthroplasty is a predictable and effective method for decreasing pain and restoring function in elderly patients with chronic elbow dislocation or fracture dislocation. The rapid functional improvement provided by this procedure allows patients to return to activities of daily living early.

Total elbow arthroplasty for primary osteoarthritis

Primary osteoarthritis of the elbow is a less common indication for total elbow arthroplasty (TEA). Higher complication rates in younger, active patients may offset short-term improvements in pain and function. The purpose of this study was to determine pain relief, functional outcomes, complications, and survival of TEA in this population. Between 1984 and 2011, 20 consecutive TEAs were performed for primary elbow osteoarthritis. Two patients died before the 2-year follow-up. Mean age at surgery was 68 years (range, 51-85 years). Outcome measures included pain, motion, Mayo Elbow Performance Score, satisfaction, complications, and reoperations. Mean follow-up was 8.9 years (range, 2-20 years). Three elbows sustained mechanical failures. Complications included intraoperative fracture (n = 2), wound irrigation and débridement (n = 1), bony ankylosis (n = 1), humeral loosening (n = 1), humeral component fracture (n = 1), and mechanical failure of a radial head component (n = 1). Fifteen elbows without mechanical failure were examined clinically. Pain improved from 3.6 to 1.5 (P < .001). Range of motion remained clinically unchanged (P > .05), with preoperative flexion contractures not improving. Mayo Elbow Performance Scores were available for 13 elbows without mechanical failure, averaging 81.5 points (range, 60-100 points); these were graded as excellent (n = 5), good (n = 2), and fair (n = 6). Subjectively, all patients without mechanical failure were satisfied. TEA represents a reliable surgical option for pain relief in patients with primary osteoarthritis. However, restoration of extension is not always obtained, indicating that more aggressive soft tissue releases or bony resection should be considered. Complications occurred in a large number of elbows, but mechanical failure was low considering the nature of this population and the length of follow-up.

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

BackgroundWith improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase. Despite these advances, complication rates remain as high as 24%. Of these complications periprosthetic joint infection is one of the most common and morbid. The rheumatoid elbow remains a leading indication for total elbow arthroplasty. Patients with this condition frequently require immunosuppressive therapy, which places them at higher risk of both typical and atypical infections.Case presentationWe present the case of a persistent, late-onset periprosthetic joint infection in a total elbow arthroplasty of a 64-year-old Caucasian woman with severe refractory rheumatoid arthritis. The offending pathogen, Aspergillus terreus, is previously unreported in the arthroplasty literature and grew concurrently with coagulase-negative staphylococcus. Eradication of the fungal and bacterial agents involved resection arthroplasty, serial debridement, and multiple courses of intravenous and oral antimicrobial therapy. Two attempts at reimplantation arthroplasty failed to eliminate the infection and our patient ultimately required definitive resection arthroplasty.ConclusionsArthroplasty in the rheumatoid elbow confers with it a high complication rate. Inflammatory disease and immunosuppressive drugs combined with the subcutaneous anatomy of the elbow contribute to the risk of infection. Fungal periprosthetic joint infection in the rheumatoid patient presents both diagnostic and therapeutic challenges. Fungal growth should always be treated and requires organism-specific antimicrobials in conjunction with surgical debridement. More literature is needed to determine the optimal treatment regimen for this devastating complication.

Total Elbow Replacement - Implantation of the Latitude Prosthesis (Tornier)

Due to technical progress, the indication for total elbow arthroplasty could be expanded in recent years. As a result, the demand regarding functionality and mobility of the replaced joint has risen as well. Elbow arthroplasty has to be considered as technically demanding. Only with detailed knowledge of this surgical procedure and its possible intraoperative pitfalls can one provide the best possible results. In this instructional video we explain the implantation of the Latitude elbow prosthesis (Tornier) putting emphasis on the correct approach as well as implantation of the prosthesis and subsequent wound closure.

Extended Olecranon Osteotomy for Revision Total Elbow Arthroplasty

Widening surgical indications for total elbow arthroplasty have resulted in increasing rates of implantation over the past several years. The need for advanced surgical techniques in the event of revision surgical treatment has become more apparent with time. Extraction of the ulnar component can be particularly challenging if well-fixed. The extended olecranon osteotomy for exposure of the ulnar intramedullary canal, cement mantle, and component was developed to address these concerns. Cadaveric dissection, implantation, osteotomy, and extraction of a total elbow arthroplasty were performed using an extended olecranon osteotomy. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique for extended olecranon osteotomy provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. The osteotomy configuration provides a large surface area for bony healing, thus restoring the integrity of the proximal ulna for later cemented reimplantation. The patient displayed osteotomy healing despite concomitant treatment for a periprosthetic joint infection.

Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008

Total elbow arthroplasty (TEA) is an established treatment for late-stage arthritis of the elbow. Indications have expanded to osteoarthritis and nonunion in distal humeral fractures. Information on implant survival and risk factors for revision is still sparse. The aim of this study was to evaluate implant survival and risk factors for revision of TEAs inserted in patients in the eastern part of Denmark in the period from 1980 until 2008. The Danish National Patient Register provided personal identification numbers for patients who underwent TEA procedures from 1980 until 2008. On the basis of a review of medical reports and linkage to the National Patient Register, we calculated revision rates and evaluated potential risk factors for revision, including, age, sex, period, indication for TEA, and implant design. We evaluated 324 primary TEA procedures in 234 patients at a mean follow-up of 8.7 years (range, 0-27 years). The overall 5-year survival was 90% (95% confidence interval [CI], 88%-94%), and 10-year survival was 81% (95% CI, 76%-86%). TEAs performed with the unlinked design had a relative risk of revision of 1.9 (95% CI, 1.1-3.2) compared with the linked design. Fracture sequelae was associated with a relative risk of revision of 1.9 (95% CI, 1.05-3.45). We found acceptable implant survival rates after 5 and 10 years, with a higher revision rate for the unlinked design and primary TEA due to fracture sequelae. Patient-related outcome measures should be included in future studies for further elaboration of the outcomes after TEA. Level III, Retrospective cohort design, treatment study.