Total elbow arthroplasty—a historical review

Background: This review aims to examine the evolution of total elbow arthroplasty (TEA) implant designs to understand common reasons for failure and optimal strategies to address them. TEA has evolved significantly since its inception, with advancements in biomaterials and implant engineering improving longevity. However, complications such as aseptic loosening, wear-related failure, periprosthetic fracture, infection, and instability remain prevalent. Early TEA designs often mimicked knee replacements and faced high failure rates secondary to poor biomechanics and material limitations. Over time, material improvements, such as titanium alloys and cobalt-chromium components, and refined implant designs have enhanced outcomes. Results: The review identifies key risk factors for TEA failure, including material degradation, technical errors, patient characteristics, and uneven mechanical stress distribution. Advances in implant materials, such as highly cross-linked polyethylene, have significantly reduced wear rates. Improved surgical techniques and patient selection criteria have also contributed to better outcomes. Despite these advancements, challenges persist, particularly in younger and more active patients who place higher mechanical demands on the implants. Discussion and Conclusion: Future research should focus on refining implant biomechanics, developing biofilm-resistant materials, and integrating robotic-assisted surgical techniques to further reduce failure rates and improve long-term outcomes. Enhanced patient education on activity modifications and adherence to postoperative guidelines are crucial for the success of TEA.