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.
Pitfalls & Challenges
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. The total elbow arthroplasty provides the pain relief and improvement in activities. The bone graft is an adjunct to achieve stability of the implant.
An increasing number of total elbow arthroplasties have been performed over the past several decades, and it is a treatment option for some patients with arthritic elbows1,2. With the …
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