Yong Girl Rhee1, Nam Su Cho1, Chong Suck Parke1. 1. Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, South Korea. E-mail address for Y.G. Rhee: shoulderrhee@hanmail.net. E-mail address for N.S. Cho: nscos1212@empas.com. E-mail address for C.S. Parke: shoulderdoc@hanmail.net.
Abstract
INTRODUCTION: Impaction grafting in revision arthroplasty for aseptic loosening of a semiconstrained total elbow replacement with severe bone loss can provide adequate implant fixation and stability with minimal resorption. STEP 1 PREOPERATIVE ASSESSMENT: Confirm aseptic loosening by preoperative radiographic evaluation and a workup for infection. STEP 2 SURGICAL APPROACH: Use the previous incision. STEP 3 IMPLANT REMOVAL: Thoroughly debride soft tissue while saving as much cortex as possible. STEP 4 ULNAR SIDE PREPARATION: Insert the guidewire under fluoroscopic guidance and use a cannulated flexible reamer; placing the guidewire past the sclerotic dome (pedestal) of the cortical balloon prevents misplacement of the revision stems. STEP 5 HUMERAL SIDE PREPARATION: Prepare the humeral side in a manner similar to that on the ulnar side. STEP 6 IMPACTION ALLOGRAFTING AND LINKING PROSTHESIS: Using a trial stem in situ, tightly pack morselized bone graft into the medullary canal of both the ulna and the humerus. STEP 7 POSTOPERATIVE CARE: Active flexion and extension with the patient wearing a brace starts at two weeks postoperatively, the brace is removed at six weeks postoperatively, and the patient is allowed to return to daily activity beginning three months postoperatively. RESULTS: We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of semiconstrained total elbow replacements.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Impaction grafting in revision arthroplasty for aseptic loosening of a semiconstrained total elbow replacement with severe bone loss can provide adequate implant fixation and stability with minimal resorption. STEP 1 PREOPERATIVE ASSESSMENT: Confirm aseptic loosening by preoperative radiographic evaluation and a workup for infection. STEP 2 SURGICAL APPROACH: Use the previous incision. STEP 3 IMPLANT REMOVAL: Thoroughly debride soft tissue while saving as much cortex as possible. STEP 4 ULNAR SIDE PREPARATION: Insert the guidewire under fluoroscopic guidance and use a cannulated flexible reamer; placing the guidewire past the sclerotic dome (pedestal) of the cortical balloon prevents misplacement of the revision stems. STEP 5 HUMERAL SIDE PREPARATION: Prepare the humeral side in a manner similar to that on the ulnar side. STEP 6 IMPACTION ALLOGRAFTING AND LINKING PROSTHESIS: Using a trial stem in situ, tightly pack morselized bone graft into the medullary canal of both the ulna and the humerus. STEP 7 POSTOPERATIVE CARE: Active flexion and extension with the patient wearing a brace starts at two weeks postoperatively, the brace is removed at six weeks postoperatively, and the patient is allowed to return to daily activity beginning three months postoperatively. RESULTS: We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of semiconstrained total elbow replacements.IndicationsContraindicationsPitfalls & Challenges.