Revision Total Elbow Arthroplasty: Surgical Technique

Abstract

Total elbow arthroplasty (TEA) can be a very gratifying procedure, restoring function and relieving pain. However, in spite of recent improvements in technique, it has a higher complications rate than other joint replacements. The most common causes of revision are infection, fractures and aseptic loosening. Infections after TEA are more common than in other joints, probably due to the precarious tissue coverage over the elbow and poor immunity in rheumatoid patients. Diagnosing elbow infection may be difficult due to nonspecific clinical symptoms and poor sensitivity of inflammatory blood markers. When present, pain at rest, progressive loss of motion or early loosening should make us suspicious of infection. When an elbow replacement has a chronic infection, surgical options include one- or two-stage revision and resection arthroplasty. Retention of components after throughout debridement is reserved for acute infections due to selected microorganisms. Chronic suppression is limited to frail patients not eligible for a surgical procedure. Periprosthetic fractures may compromise implant stability and require stem revision. Revision stems should bypass the fracture line at less than 2-width diameters. When enough rotational stability is not achieved, additional fixation with cerclages or plates may be needed. Aseptic loosening may present with significant bone loss. Several augmentation strategies may be used: bone strut allografts in cortical defects, impaction grafting in contained defect with intact cortex or prosthetic-allograft composites when there is a massive bone loss. Aseptic loosening often requires cement removal. When the cement mantle is intact and there is no infection, cement-on-cement revision techniques may be preferred.