Arch Hand Microsurg.  2020 Jun;25(2):101-107. 10.12790/ahm.20.0021.

Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

• Chae YJ
• Gong HS

• KMID: 2502705
• DOI: http://doi.org/10.12790/ahm.20.0021

Abstract

Purpose
The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC).
Methods
We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications.
Results
The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later.
Conclusion
Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

Keyword

Arthroplasty; Replacement; Elbow; Allobone-prosthesis

Figure

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  Fig. 1. A 76-year-old woman with periprosthetic fracture in the proximal ulna. (A) Preoperative radiographs, (B) postoperative radiographs. (C) In the intraoperative field, we used the tendon-attached ulnar allobone for triceps reconstruction. The tendon-attached ulnar allobone (black arrowhead) was coapted with the hostbone in a step-cut configuration with cerclage wiring fixation. (D) The triceps musculotendinous part was sutured (black arrowhead) to the allotendon that is attached to the allobone. (E) Follow-up radiographs taken at 6 months after surgery show callus formation at the junction between the allobone and hostbone.

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  Fig. 2. A 76-year-old woman with periprosthetic fracture in distal humerus. (A) Preoperative radiographs, (B) postoperative radiographs show step-cut coaptation with cerclage wiring fixation, use of a long stem with firm cementing in the humerus. (C) Follow-up radiographs taken at 9 months after surgery show bone union at the junction between the allobone and hostbone.

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