Which primary shoulder and elbow replacement? A review of the results of prostheses available in the UK

To assist surgeons select a suitable prosthesis, we have undertaken a detai led review of all shoulder and elbow replacements currently marketed in the UK. Twenty shoulder and 8 elbow implants, manufactured by 16 companies, ha ve been identified. Twelve of the shoulder and one of the elbow implants ha ve been introduced or modified in the last 8 years and have no clinical res ults published in peer-reviewed journals. Only the Biomodular, Bipolar, Cop eland, Isoelastic, Neer hemi, Neer II, Roper-Day and Select shoulders accou nting for less than 40% of the UK shoulder market, possess published result s. The Capitello-condylar, Coonrad-Morrey, GSB III, Kudo, Liverpool, Roper- Tuke and Souter-Strathclyde elbows all have published results. These accoun t for over 95% of all UK elbow replacements. The implications of these find ings in an era of evidence-based medicine is discussed. Reviewing the clini cal results should be of primary importance in the selection of a suitable prosthesis. Implants with a proven long-term record must represent the 'gol d standard'. New or modified implants should only be used if they are part of a properly conducted clinical trial.