Revision Total Elbow Arthroplasty for Prosthetic Fractures

Abstract

Therapeutic Level IV.

Upper extremity reconstruction with a humeral tumor endoprosthesis: A novel salvage procedure after multiple revisions of total shoulder and elbow replacements

“…Although these complications are rare, the authors concluded that component fracture may be related to notch sensitivity, component design, and high stresses due to bone deficiency. 4 Previously, our patient had a fall and required revision TEA for a fractured humeral component. In addition to the direct impact at the elbow, compromised integrity of her osseous tissue may have also contributed to undue component stress.…”

“…4,14,17,22 Certainly, the potential exists that a combination of these factors contributed to the acceleration of our patient's extensive bone loss and compromised bone stock. Athwal and Morrey 4 have previously reported humeral and ulnar fracture rates of 0.65% and 1.2%, respectively, after primary TEA.…”

“…21,23 Infection, periprosthetic fracture, component malpositioning, dislocation, and wear osteolysis are welldocumented arthroplasty complications, often necessitating revision, 2,4,5,9,10,[12][13][14][20][21][22][23] thus requiring the surgeon to address deficiencies of both the soft and osseous tissues, as well as the implant itself.…”

Total Elbow Arthroplasty: Surgical Technique

“…• Periprosthetic fractures with a well-fixed component may require cortical allograft struts and band- ing for reconstruction. 6,7 Periprosthetic fractures with a loose component require revision with a longer stem, as well as cortical allograft struts and banding. Surgery for a loosened component before periprosthetic fracture will require revision of the component, as well as possible impaction bone grafting for intramedullary bone loss.…”

Surgical Options for the Arthritic Elbow

“…According to 1 series, the prevalences of humeral and ulnar component prosthetic elbow fracture were 0.65% and 1.2%, respectively. 40 Periprosthetic fractures in which the components are stable can be treated nonsurgically or by open reduction with internal fixation. For unstable components, revision arthroplasty with conversion to a longer stem should be performed.…”