Analyzing Declining Trends, Patient Demographics, and Complications in Total Elbow Arthroplasty: A Nationwide Retrospective Data

Background Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. The study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess patient characteristics and outcomes associations. Results A total of 4,110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p=0.012). The cohort had a mean age of 65.99 years, predominating female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were $78,473 (IQR: $56,935–$115,671). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of improving outcomes through patient optimization, surgical expertise, and postoperative monitoring. Future research should focus on refining prosthetic designs and standardizing postoperative care protocols to enhance TEA longevity and safety.