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Impaction Grafting in Revision Total Elbow Arthroplasty for Aseptic Loosening and Bone LossSurgical Technique
Yong Girl Rhee, MD1; Nam Su Cho, MD1; Chong Suck Parke, MD1
1 Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, South Korea. E-mail address for Y.G. Rhee: shoulderrhee@hanmail.net. E-mail address for N.S. Cho: nscos1212@empas.com. E-mail address for C.S. Parke: shoulderdoc@hanmail.net
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Based on an original article: J Bone Joint Surg Am. 2013 Jun 5;95(11):e74.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Sep 11;3(3):e17 1-8. doi: 10.2106/JBJS.ST.M.00018
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Extract

Overview
Introduction

Impaction grafting in revision arthroplasty for aseptic loosening of a semiconstrained total elbow replacement with severe bone loss can provide adequate implant fixation and stability with minimal resorption.

Step 1: Preoperative Assessment

Confirm aseptic loosening by preoperative radiographic evaluation and a workup for infection.

Step 2: Surgical Approach

Use the previous incision.

Step 3: Implant Removal

Thoroughly debride soft tissue while saving as much cortex as possible.

Step 4: Ulnar Side Preparation

Insert the guidewire under fluoroscopic guidance and use a cannulated flexible reamer; placing the guidewire past the sclerotic dome (pedestal) of the cortical balloon prevents misplacement of the revision stems.

Step 5: Humeral Side Preparation

Prepare the humeral side in a manner similar to that on the ulnar side.

Step 6: Impaction Allografting and Linking Prosthesis

Using a trial stem in situ, tightly pack morselized bone graft into the medullary canal of both the ulna and the humerus.

Step 7: Postoperative Care

Active flexion and extension with the patient wearing a brace starts at two weeks postoperatively, the brace is removed at six weeks postoperatively, and the patient is allowed to return to daily activity beginning three months postoperatively.

Results

We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of semiconstrained total elbow replacements.

Indications

Contraindications

Pitfalls & Challenges

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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