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 Shoulder/Elbow Test 4: The Elbow: Arthroplasty, Trauma
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The Journal of Bone and Joint Surgery (American) 86:724-735 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Allograft-Prosthesis Composite for Revision of Catastrophic Failure of Total Elbow Arthroplasty

Pierre Mansat, MD, PhD1, Robert A. Adams, PA2 and Bernard F. Morrey, MD2

1 Service d'Orthopédie et Traumatologie, Hôpital Universitaire de Toulouse-Purpan, Place du Dr Baylac, 31059, Toulouse, France
2 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Zimmer, Warsaw, Indiana). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Revision of a failed total elbow arthroplasty is a challenging procedure, often associated with bone deficiency. The purpose of this investigation was to review our experience with a composite allograft-implant reconstruction for patients with a failed total elbow arthroplasty.

Methods: Thirteen patients (thirteen elbows) in whom a total elbow arthroplasty had failed, primarily as a result of loosening of the humeral or ulnar component, were operated on with use of an allograft-prosthesis composite; the composite was placed on the humeral side in four of these patients and on the ulnar side in nine. The delay between the last total elbow arthroplasty and the allograft-prosthesis-composite procedure averaged eight years.

Results: At an average of forty-two months after the revision, the Mayo Elbow Performance Score was excellent for four elbows, good for three, fair for one, and poor for five. Nine of the thirteen patients had no or only slight pain in the elbow. The mean arc of flexion was 97°, with an average of 28°(range, 0° to 60°) of extension to 125° (range, 100° to 140°) of flexion. There were seven complications affecting seven elbows, and five of the seven required a revision procedure. Deep infection developed in four elbows, and the allograft-prosthesis composite had to be removed from three. Two nonunions occurred at the allograft-humeral junction.

Conclusions: An allograft-prosthesis composite can be a valuable option in selected patients with a failed total elbow arthroplasty with massive bone loss. The union and implant survival rates are high. Deep infection remains the main complication. Hence, we recommend the pursuit of other revision options, such as strut graft reconstruction, whenever possible before resorting to the use of an allograft-prosthesis composite in the surgical treatment of a failed total elbow arthroplasty with massive bone loss.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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