Revision Arthroplasty for the Aseptic Loosening after Semiconstrained Total Elbow Replacement - Midterm Results -

Jin Woong Yi; Jae Keun Ko; Nam Su Cho; Yong Girl Rhee

doi:10.4055/jkoa.2008.43.4.465

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Yi, Ko, Cho, and Rhee: Revision Arthroplasty for the Aseptic Loosening after Semiconstrained Total Elbow Replacement - Midterm Results -

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(4): 465-472.

Published online: 31 August 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.4.465

Revision Arthroplasty for the Aseptic Loosening after Semiconstrained Total Elbow Replacement - Midterm Results -

Jin Woong Yi, M.D., Jae Keun Ko, M.D.^*, Nam Su Cho, M.D.^†, Yong Girl Rhee, M.D.^‡

Department of Orthopaedic Surgery, School of Medicine, Konyang University, Daejeon, Korea.

^*Department of Orthopaedic Surgery, Hong Je Hospital, Busan, Korea.

^†Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, East-West Neo Medical Center, Korea.

^‡Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.

Address reprint requests to Yong Girl Rhee, M.D. Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, 1, Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea. Tel: +82.2-958-8370, Fax: +82.2-958-3865, shoulderrhee@hanmail.net

Abstract

Purpose

To analyze the clinical results of revision arthroplasty for aseptic loosening after performing semiconstrained total elbow replacement.

Materials and Methods

We retrospectively analyzed fifteen patients that had undergone aseptic loosening after semiconstrained total elbow replacement who also had revision arthroplasty. There were 4 men and 11 women, with a mean age of 57 years. The average duration of follow-up was 54 months. The primary causes of arthroplasty were posttraumatic arthrosis (five cases), rheumatoid arthritis (four cases), primary osteoarthritis (four cases), ankylosis (one case) and Charcot joint (one case). For eleven (73%) elbows, the cementing technique was considered marginal or inadequate at the time of primary arthroplasty. An impaction bone graft was used in seven patients at revision, a strut allograft was used in four patients and cement alone was used in four patients.

Results

The average preoperative Mayo elbow performance score was 56.6 points; the average postoperative score was 84.5 points. At the latest follow-up, according to the Mayo elbow performance index, six patient elbows showed an excellent result, six patient elbows showed a good result, one patient elbow had a fair result and two patient elbows showed a poor result. Aseptic loosening occurred in three of four elbows that had been revised with cement only.

Conclusion

Revision arthroplasty for aseptic loosening after semiconstrained total elbow replacement was useful for the relief of pain, maintenance of stability and the activities of daily living. A poor cementing technique and an inadequate selection of implant may be associated with loosening as a main risk factor. Revision using an impaction graft or strut allograft can be a reliable technique for treating a failed total elbow arthroplasty with massive bone loss.

Keywords: Elbow, Aseptic loosening, Revision total elbow replacement, Strut allograft, Impaction bone graft

Figures and Tables

Fig. 1

(A) Preoperative radiographs show severe bony resorption at the proximal ulna and the distal humerus. (B) Postoperative radiographs 5 years after revision total elbow replacement with impaction bone graft show no evidence of resorption or prosthetic loosening around the distal humerus and proximal ulna.

Fig. 2

A 66-year-old woman. (A) Radiographs of the elbow before the revision surgery. The radiographs show aseptic loosening. (B) The patient was treated with a structural allograft and plate fixation for a bone defect of the proximal ulna. (C) The last follow-up radiograph shows a stable component without loosening.

Table 1

Summary of Cases

^*Morrey et al. classification13).

Table 2

Preoperative and Postoperative Range of Motion

Table 3

The Preoperative and Postoperative Mayo Elbow Performance Index

Mayo elbow performance index: Excellent >90; Good 75-89; Fair 60-74; Poor <60.

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