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The Journal of Bone and Joint Surgery (American) 86:1223-1229 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Proximal Ulnar Reconstruction with Strut Allograft in Revision Total Elbow Arthroplasty

S. Kamineni, FRCS(Orth)1 and B.F. Morrey, MD2

1 Department of Orthopaedics and Biomechanics, Imperial College London and Hillingdon Hospital NHS Trust, South Kensington Campus, London SW7 2AZ, United Kingdom
2 Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. B.F. Morrey received royalities with the Conrad-Morrey total elbow arthroplasty. 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: The growing frequency of joint arthroplasty has led to increasing numbers of patients requiring revision surgery. In the treatment of a failed total elbow arthroplasty not associated with infection, one of the main issues is poor or absent proximal ulnar bone stock due to osteolysis. We report our experience with the use of strut allograft reconstruction of the proximal part of the ulna as an adjunct to revision total elbow arthroplasty with a noncustom implant. Our aim was to better define the indications, outcomes, and complications of this technique in a population of patients with a failed total elbow arthroplasty.

Methods: We reviewed the cases of patients with aseptic failure of a total elbow replacement and proximal ulnar bone deficiency who were treated with allograft bone struts. The patients had had an average of 2.5 (range, one to four) prior open osseous operations addressing the elbow joint. In addition to revision of the prosthetic components, the deficient bone stock was treated with allograft strut grafts in one of four ways: (1) discrete cortical defects were contained, (2) periprosthetic fractures were splinted, (3) deficient triceps attachments were reconstructed, and (4) expanded segments were augmented with struts and filled with impaction graft. Twenty-one patients (twenty-two elbows) were followed for an average of four years (range, two to eleven years).

Results: The mean Mayo Elbow Performance Score improved from 34 points preoperatively to 79 points at the time of the latest follow-up. The scores for pain, stability, and activities of daily living improved most; there was little change in motion. Complications, consisting of four soft-tissue and four osseous problems, occurred in eight patients. Three patients had incorporation of 26% to 50% of the graft; five, 51% to 75%; and fourteen, 76% to 100%.

Conclusions: Most deficiencies of proximal ulnar bone stock and fractures complicating revision total elbow surgery can be treated with allograft strut grafting. Although the complication rate is high, this technique is suitable for discrete cortical lesions, periprosthetic fractures, and an expanded proximal part of the ulna, which also requires augmentation with impaction grafting. The technique has been unreliable, however, in restoring deficient olecranon bone stock.

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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G. S. Athwal and B. F. Morrey
Revision Total Elbow Arthroplasty for Prosthetic Fractures
J. Bone Joint Surg. Am., September 1, 2006; 88(9): 2017 - 2026.
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