Abstract
Background: Total elbow arthroplasty (TEA) has evolved over time from a salvage procedure to a successful treatment of end-stage primary and secondary arthritis. However, the aseptic loosening and the associated reduced survival rate are still concerning. Thus, TEA is typically contraindicated in young and active patients where high-demand activities would promote aseptic loosening. For this reason, postoperative weightlifting limitations are often suggested, yet there is no consensus. The aim of this survey was to collect and analyze the current practice concerning the weightlifting restrictions following elbow arthroplasties among members of the Italian Society of Shoulder and Elbow Surgery (Società Italiana Chirurgia Spalla e Gomito, SICSeG). Methods: An online survey on the lifting restrictions after elbow arthroplasties was submitted to all members of the SICSeG. Results: In total, 36 members of the Italian society completed the survey. Only five consultants (13.8%) have experience with all the implants analyzed, of whom only three have experience with more than 10 implants per year. Concerning the comprehensive number of elbow arthroplasties performed per year, most of the respondents (45.7%) reported fewer than five surgeries per year, whereas only two surgeons claimed more than 20 procedures. Of the 36 respondents, 32 (88.9%) reported lifelong lifting limitations after linked TEA. In detail, these lifting restrictions were 10 lb in 14 responders (38.9%) and 5 lb in 15 responders (41.7%) performing linked TEA. A lifelong lifting limitation gradually decreased after unlinked TEA and hemiarthroplasty (HA) being advised by 82.8% (24/36) and 64.5% (20/36), respectively. Conclusions: To increase implant longevity, most Italian surgeons advise lifting restrictions after TEA. More than 80% of the responders agreed with suggesting lifelong limitations, but a greater variability was found in the amount of weight to which the patients are restricted. Currently, the lack of consensus on the optimal weightlifting restrictions after elbow replacements emphasizes the need for more studies focusing on elbow joint loading during different activities of daily life to improve implant survival rates.