Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss

Abstract

We studied, ten patients (11 elbows) who had undergone 14 allograft-prosthesis composite reconstructions following failure of a previous total elbow replacement with massive structural bone loss. There were nine women and one man with a mean age of 64 years (40 to 84), who were reviewed at a mean of 75 months (24 to 213). One patient developed a deep infection after 26 months and had the allograft-prosthesis composite removed, and two patients had mild pain. The median flexion-extension arc was 100° (95% confidence interval (CI) 76° to 124°). With the exception of the patient who had the infected failure, all the patients could use their elbows comfortably without splints or braces for activities of daily living. The mean Mayo Elbow Performance Index improved from 9.5 (95% CI 4.4 to 14.7) pre-operatively to 74 (95% CI 62.4 to 84.9) at final review. Radiologically, the rate of partial resorption was similar in the humeral and ulnar allografts (three of six and four of eight, respectively; p > 0.999). The patterns of resorption, however, were different. Union at the host-bone-allograft junction was also different between the humeral and ulnar allografts (one of six and seven of eight showing union, respectively; p = 0.03). At medium-term follow-up, allograft-prosthesis composite reconstruction appears to be a useful salvage technique for failed elbow replacements with massive bone loss. The effects of allograft resorption and host-bone-allograft junctional union on the longevity of allograft-prosthesis composite reconstruction, however, remain unknown, and it is our view that these patients should remain under long-term regular review.

Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries

“…Both trauma patients with deep infections required implant removal followed by medication therapy. These complication rates are comparable with those reported by other authors [7,12,16,17,21,24,25,37–39]. …”

“…The evaluation of treatment outcomes was based on the Mayo Elbow Performance Score (MEPS) and the Quick DASH scale [24–27]. …”

Revision total elbow replacement

“…4 Rheumatoid patients often have reduced bone density 5 and the peri-articular bone quality in the failing TER is compounded by stress shielding or osteolysis and aseptic loosening. Auto-or allograft bone graft, allograft-prothesis composites 6 or megaprostheses 7,8 may be required in the presence of massive bone loss. If the dominant primary stability of the revision implant will be gained in a region distal to the isthmus, and fixation in the medullary cavity (which tends to expand towards the metaphyseal region) is required, then the revision implant may need to be longer than the standard recommendation of at least two cortical diameter widths.…”

Prothese, Resektionsarthroplastik oder Arthrodese als Salvageverfahren

“…Dabei konnte nur in 9 Fällen eine "graft to host union" beobachtet werden. Amryfeitz [2] Dies liegt unter anderem an den lokal dünnen Weichteilverhältnissen, einer fehlenden muskulären Deckung der exponierten Knochenstrukturen, so wie dies bei der proximalen Ulna vorliegt. Die Hauptpopulation, die eine Ellenbogenprothese benötigt, ist immer noch der Polyarthritispatient.…”