Elbow joint biomechanics during ADL focusing on total elbow arthroplasty: a scoping review

Daniëlle Meijering*, Roos Duijn, Alessio Murgia, Lex Boerboom, Denise Eygendaal, Michel P. J. van den Bekerom, Sjoerd K. Bulstra, Martin Stevens, Riemer Vegter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background Overloading is hypothesized to be one of the failure mechanisms following total elbow arthroplasty
(TEA). It is unclear whether the current post-operative loading instruction is compliant with reported failure mechanisms.
Aim is therefore to evaluate the elbow joint load during activities of daily living (ADL) and compare these loads
with reported failure limits from retrieval and finite element studies.
Methods A scoping review of studies until 23 November 2021 investigating elbow joint load during ADL were identified
by searching PubMed/Medline and Web of Science. Studies were eligible when: (1) reporting on the elbow joint
load in native elbows or elbows with an elbow arthroplasty in adults; (2) full-text article was available.
Results Twenty-eight studies with a total of 256 participants were included. Methodological quality was low in 3,
moderate in 22 and high in 3 studies. Studies were categorized as 1) close to the body and 2) further away from the
body. Tasks were then subdivided into: 1) cyclic flexion/extension, 2) push-up, 3) reaching, 4) self-care, 5) work. Mean
flexion–extension joint load was 17 Nm, mean varus-valgus joint load 9 Nm, mean pronation-supination joint load 8
Nm and mean bone-on-bone contact force 337 N.
Conclusion The results of our scoping review give a first overview of the current knowledge on elbow joint loads
during ADL. Surprisingly, the current literature is not sufficient to formulate a postoperative instruction for elbow joint
loading, which is compliant with failure limits of the prosthesis. In addition, our current instruction does not appear
to be evidence-based. Our recommendations offer a starting point to assist clinicians in providing informed decisions
about post-operative instructions for their patients.
Original languageEnglish
Article number42
Pages (from-to)1-10
Number of pages10
JournalBmc Musculoskeletal Disorders
Publication statusPublished - 18-Jan-2023


  • Elbow joint loading, Elbow prosthesis, Arthroplasty, Biomechanical analysis, Activities of daily living

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