Extended Olecranon Osteotomy for Removal of a Well-fixed, Total Elbow Ulnar Component

Abstract

Infection after total elbow arthroplasty (TEA) can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat infection but typically results in significant functional disability. Components may be well fixed and removal may further compromise bone and soft tissue. We present a technique of ulnar osteotomy that facilitates removal of a well-fixed ulnar component and the associated cement mantle while preserving the extensor mechanism. To date, we have performed this procedure on 5 patients. After resection and appropriate antibiotic treatment, 3 patients had reimplantation of a TEA, 1 patient had elbow arthrodesis, and 1 patient elected for a resection arthroplasty. Eradication of infection was achieved in all patients. In suitable patients, this technique can be used to remove a well-fixed ulnar component with the preservation of the extensor mechanism.