Impaction Grafting in Revision Total Elbow Arthroplasty for Aseptic Loosening and Bone Loss: Surgical Technique.

Abstract

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. Confirm aseptic loosening by preoperative radiographic evaluation and a workup for infection. Use the previous incision. Thoroughly debride soft tissue while saving as much cortex as possible. 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. Prepare the humeral side in a manner similar to that on the ulnar side. Using a trial stem in situ, tightly pack morselized bone graft into the medullary canal of both the ulna and the humerus. 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. We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of semiconstrained total elbow replacements.IndicationsContraindicationsPitfalls & Challenges.