Outcomes following revision of the revision total elbow arthroplasty

Radial Forearm Vascularized Osteomuscular Flap for Proximal Ulnar Deficiency After Revision Total Elbow Arthroplasty

“…Although revision TEA has shown improvements in postoperative functional outcomes, these procedures are nonetheless associated with high reoperation rates 17 . Secondary revision of a previously revised TEA is often complicated by both bony and soft-tissue deficiencies because of scar tissue formation, stress shielding from larger implants, and the local tissue trauma associated with a reoperated wound bed 18 . As the frequency of primary and revision TEA continues to increase, management of the failed TEA is an important area of investigation.…”

Proximal Humeral Replacement With Osteoarticular Allograft Prosthetic Composite in Failed Revision Total Elbow Arthroplasty With Marked Bone Loss

“…Traditionally outcomes of the multiply revised TEA have been relatively poor and unpredictable. Domos et al retrospectively evaluated outcomes following TEA in the setting of multiple revisions 4. They evaluated 14 patients with a median of 3 prior TEA revisions.…”

“…Allograft reconstruction was performed in 50% and endoprosthesis reconstruction was performed in 30% of revisions. They found that increasing the total number of revisions was associated with lower Mayo Elbow Performance Index scores (45 vs. 55; P =0.42), a lower flexion-extension arc (110 vs. 60 degrees; P =0.02) and a lower pronosupination arc (115 vs. 60 degrees; P =0.08), compared with patients who had undergone ≤3 revisions 4…”

“…Domos et al retrospectively evaluated outcomes following TEA in the setting of multiple revisions. 4 They evaluated 14 patients with a median of 3 prior TEA revisions. Their most common indications for revision were aseptic loosening (60%) followed by bushing wear (16%), fracture (14%), and infection (10%).…”

“…They found that increasing the total number of revisions was associated with lower Mayo Elbow Performance Index scores (45 vs. 55; P = 0.42), a lower flexion-extension arc (110 vs. 60 degrees; P = 0.02) and a lower pronosupination arc (115 vs. 60 degrees; P = 0.08), compared with patients who had undergone ≤ 3 revisions. 4 The multiple revision TEA can be an exceedingly challenging operation given the massive bone loss that accompanies revision procedures. There have been several techniques described to address accompanying bone loss in the revision setting including impaction grafting, 5 bulk or strut allografts, 6 mega (tumor) endoprostheses, 7 and allograft prosthetic composites.…”