Unexpected high early failure rate of the Nexel total elbow arthroplasty

Mark E. Morrey, Chad Songy, Jacob J. Triplet, Adnan N. Cheema, Shawn W. O'Driscoll, Joaquin Sanchez-Sotelo, Bernard F. Morrey

Research output: Contribution to journalArticlepeer-review


Background: Aseptic loosening, polyethylene wear, and mechanical failure have limited the use of total elbow arthroplasty (TEA) in physically demanding patients. Newer implant designs have been introduced to improve mechanical performance. The purpose of this study was to report the results obtained after implantation of the Nexel TEA. Methods: Over a 3-year period, 2 surgeons implanted a total of 35 consecutive Nexel primary TEAs. The average patient age was 65 years, and standard TEA indications were utilized. Elbows were evaluated for pain, motion, the Mayo Elbow Performance Score, complications, and reoperations. Results: Twelve elbows underwent a revision surgery with removal of either a part of or all Nexel components at an average of 2.2 years. All revision surgeries performed at our institution revealed gross loosening of the component(s). Metallic debris and periprosthetic fractures were present in 45% and 50% of cases, respectively. Radiographic evaluation of existing components revealed humeral component loosening and periprosthetic fractures in 2 and 4 elbows, respectively. Overall, 17 of 35 (50%) elbows underwent reoperation, and 20 of 35 (60%) elbows sustained at least 1 postoperative complication. Conclusion: Primary TEA with implantation of this implant was associated with an unacceptably high rate of early implant loosening, periprosthetic fracture, and reoperation. We hypothesize that this early unexpected mechanical failure could be explained by both the utilization of a titanium-on-polyethylene bearing surface and a more posterior center of rotation causing premature anterior impingement with flexion leading to failure of the bonding interface, secondary titanium particle shedding, polyethylene wear, and osteolysis.

Original languageEnglish (US)
Pages (from-to)690-695
Number of pages6
JournalJSES International
Issue number4
StatePublished - Jul 2022
Externally publishedYes


  • Aseptic loosening
  • Case Series
  • Level IV
  • Mechanical failure
  • Nexel total elbow arthroplasty
  • Polyethylene wear
  • TEA
  • Total elbow arthroplasty
  • Treatment Study

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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