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Revision Total Elbow Arthroplasty: Surgical Technique

  • Pablo Vadillo-Cardona
  • E. Carlos Rodríguez-Merchán
  • Samuel Antuña
Chapter

Abstract

Total elbow arthroplasty (TEA) can be a very gratifying procedure, restoring function and relieving pain. However, in spite of recent improvements in technique, it has a higher complications rate than other joint replacements. The most common causes of revision are infection, fractures and aseptic loosening. Infections after TEA are more common than in other joints, probably due to the precarious tissue coverage over the elbow and poor immunity in rheumatoid patients. Diagnosing elbow infection may be difficult due to nonspecific clinical symptoms and poor sensitivity of inflammatory blood markers. When present, pain at rest, progressive loss of motion or early loosening should make us suspicious of infection. When an elbow replacement has a chronic infection, surgical options include one- or two-stage revision and resection arthroplasty. Retention of components after throughout debridement is reserved for acute infections due to selected microorganisms. Chronic suppression is limited to frail patients not eligible for a surgical procedure. Periprosthetic fractures may compromise implant stability and require stem revision. Revision stems should bypass the fracture line at less than 2-width diameters. When enough rotational stability is not achieved, additional fixation with cerclages or plates may be needed. Aseptic loosening may present with significant bone loss. Several augmentation strategies may be used: bone strut allografts in cortical defects, impaction grafting in contained defect with intact cortex or prosthetic-allograft composites when there is a massive bone loss. Aseptic loosening often requires cement removal. When the cement mantle is intact and there is no infection, cement-on-cement revision techniques may be preferred.

Keywords

Revision arthroplasty Elbow Infection Fracture Bone loss Surgical technique 

References

  1. 1.
    Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elb Surg. 2010 Dec;19:1115–20.CrossRefGoogle Scholar
  2. 2.
    Cross MB, Cicalese E, Nam D, McArthur BA, Lipman JD, Figgie MP. Results of custom-fit, noncemented, semiconstrained total elbow arthroplasty for inflammatory arthritis at an average of eighteen years of follow-up. J Shoulder Elb Surg. 2014;23:1368–73.CrossRefGoogle Scholar
  3. 3.
    Sanchez-Sotelo J, O’Driscoll S, Morrey BF. Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation. J Bone Joint Surg Am. 2002;84:1642–50.CrossRefGoogle Scholar
  4. 4.
    Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps- sparing approach. Clin Orthop Relat Res. 1982;(166):188–92.Google Scholar
  5. 5.
    Alonso-Llames M. Bilaterotricipital approach to the elbow. Its application in the osteosynthesis of supra-condylar fractures of the humerus in children. Acta Orthop Scand. 1972;43:479–90.CrossRefGoogle Scholar
  6. 6.
    Athwal GS, Morrey BF. Revision total elbow arthroplasty for prosthetic fractures. J Bone Joint Surg Am. 2006;88:2017–26.CrossRefGoogle Scholar
  7. 7.
    Yamaguchi K, Adams RA, Morrey BF. Infection after total elbow arthroplasty. J Bone Joint Surg Am. 1998;80:481–91.CrossRefGoogle Scholar
  8. 8.
    Jenkins PJ, Watts AC, Norwood T, Duckworth AD, Rymaszewski LA, McEachan JE. Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop. 2013;84:119–23.CrossRefGoogle Scholar
  9. 9.
    Somerson JS, Morrey ME, Sanchez-Sotelo J, Morrey BF. Diagnosis and management of periprosthetic elbow infection. J Bone Joint Surg Am. 2015;97:1962–71.CrossRefGoogle Scholar
  10. 10.
    Wolfe SW, Figgie MP, Inglis AE, Bohn WW, Ranawat CS. Management of infection about total elbow prostheses. J Bone Joint Surg Am. 1990;72:198–212.CrossRefGoogle Scholar
  11. 11.
    Eid AJ, Berbari EF, Sia IG, Wengenack JL, Osmon DR, Razonable RR. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Clin Infect Dis. 2007;45:687–94.CrossRefGoogle Scholar
  12. 12.
    Pradier M, Robineau O, Boucher A, Titecat M, Blondiaux N, Valette M, Loïez C, Beltrand E, Nguyen S, Dézeque H, Migaud H, Senneville E. Suppressive antibiotic therapy with oral tetracyclines for prosthetic joint infections: a retrospective study of 78 patients. Infection. 2018;46:39–47.CrossRefGoogle Scholar
  13. 13.
    Cheung EV, Adams RA, Morrey BF. Reimplantation of a total elbow prosthesis following resection arthroplasty for infection. J Bone Joint Surg Am. 2008;90:589–94.CrossRefGoogle Scholar
  14. 14.
    Peach CA, Nicoletti S, Lawrence TM, Stanley D. Two-stage revision for the treatment of the infected total elbow arthroplasty. Bone Joint J. 2013;95-B:1681–6.CrossRefGoogle Scholar
  15. 15.
    King GJ, Adams RA, Morrey BF. Total elbow arthroplasty: revision with use of a non-custom semiconstrained prosthesis. J Bone Joint Surg Am. 1997;79:394–400.CrossRefGoogle Scholar
  16. 16.
    Loebengerg MI, Adams R, O’Driscoll SW, Morrey BF. Impaction grafting in revision total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:99–106.CrossRefGoogle Scholar
  17. 17.
    Rhee YG, Cho NS, Parke CS. Impaction grafting in revision total elbow arthroplasty for aseptic loosening and bone loss: surgical technique. J Bone Joint Surg Am. 2013;3:e17.CrossRefGoogle Scholar
  18. 18.
    Kamineni S, Morrey BF. Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty. J Bone Joint Surg Am. 2004;86:1223–9.CrossRefGoogle Scholar
  19. 19.
    Foruria AM, Sanchez-Sotelo J, Oh LS, Adams RA, Morrey BF. The surgical treatment of periprosthetic elbow fractures around the ulnar stem following semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2011;93:1399–407.CrossRefGoogle Scholar
  20. 20.
    Renfree KJ, Dell PC, Kozin SH, Wright TW. Total elbow arthroplasty with massive composite allografts. J Shoulder Elb Surg. 2004;13:313–21.CrossRefGoogle Scholar
  21. 21.
    Mansat P, Adams RA, Morrey BF. Allograft-prosthesis composite for revision of catastrophic failure of total elbow arthroplasty. J Bone Joint Surg Am. 2004;86:724–35.CrossRefGoogle Scholar
  22. 22.
    Morrey ME, Sanchez-Sotelo J, Abdel MP, Morrey BF. Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty. J Bone Joint Surg Am. 2013;95:1117–24.CrossRefGoogle Scholar
  23. 23.
    O’Driscoll SW, Morrey BF. Periprosthetic fractures about the elbow. Orthop Clin North Am. 1999;30:319–25.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pablo Vadillo-Cardona
    • 1
  • E. Carlos Rodríguez-Merchán
    • 1
  • Samuel Antuña
    • 1
  1. 1.Department of Orthopedic Surgery“La Paz” University HospitalMadridSpain

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