Osteoporosis Increases the Risk of Periprosthetic Fracture and Loosening after Total Elbow Arthroplasty: A Retrospective Cohort Study

Abstract

Introduction Osteoporosis may adversely affect implant fixation and bone integrity following total elbow arthroplasty (TEA), yet its impact on postoperative complications remains incompletely defined. This study compared outcomes following TEA in patients with and without osteoporosis. Methods A retrospective analysis was performed including 1,410 adult patients who underwent total elbow arthroplasty (TEA) with a minimum follow-up of two years. Patients with osteoporosis were matched to an equal number of patients without osteoporosis based on demographics, comorbidities, surgical indication, and preoperative inflammatory laboratory markers. Outcome measures included two-year rates of revision, periprosthetic fracture, implant loosening, prosthetic joint infection (PJI), ulnar nerve injury, and instability. A secondary analysis of 520 patients with osteoporosis compared those who received anti-osteoporosis medication to those who did not. Complication rates were compared between groups using chi-squared testing. Results Patients with osteoporosis had higher two-year rates of periprosthetic fracture (4.4% vs. 1.4%, p<0.001) and implant loosening (5.0% vs. 2.3%, p=0.007). There were no differences in revision (p=0.144), PJI (p=0.479), ulnar nerve injury (p=0.228), or instability (p=0.692). Among patients with osteoporosis, medication use was not associated with differences in revision, implant loosening, PJI, or ulnar nerve injury. Patients on medication had a lower rate of periprosthetic fracture that did not reach significance (p=0.061). Conclusion Osteoporosis is associated with increased risk of periprosthetic fracture and implant loosening following TEA. These findings suggest that impaired bone quality may contribute to structural modes of failure, highlighting the importance of preoperative bone health optimization in patients undergoing TEA.