Midterm outcomes allograft prosthetic composite reconstruction for massive bone loss at the elbow

Abstract

BackgroundRevision of a loose total elbow arthroplasty (TEA) is challenging, particularly in the context of massive bone loss (MBL). The use of an allograft prosthetic composite (APC) at the elbow is rare, typically reserved as a salvage procedure for MBL. Thus, limited data describing the outcomes of APCs are available in current literature. HypothesisThe authors hypothesize that short to midterm clinical outcomes of APC for MBL about the elbow are satisfactory. Patients and methodsBetween 2009 and 2018, 6 APCs implanted with a semi-constrained Coonrad Morrey prosthesis were performed in 5 females and 1 male. Median patient age was 70 years (range, 49–76 years). The indication for revision was aseptic loosening in all 6 cases (6 humeral and 2 ulnar). Median follow-up was 3.5 years (range, 2–6.7 years). Functional outcomes including Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), range of motion (ROM), and radiographic outcomes were assessed for all patients. ResultsMedian MEPS and VAS scores were 75 (range, 40–90), and 0 (range, 0–8) at latest follow-up, respectively. Median postoperative flexion-extension and prono-supination arcs were 90̊ (range, 70–140̊) and 150 (range, 100–160̊), respectively. Allograft incorporation was noted in 5 (83%) patients; all prostheses were well-fixed. In total, 4 patients (63%) experienced 5 complications (83%) including periprosthetic fracture (n=2), ulnar neuropathy (n=1), aseptic loosening (n=1), and wound dehiscence (n=1). Two (33%) required reoperation with prosthetic retention. ConclusionElbow reconstruction using allograft prosthetic composite is a viable option for patients with MBL following TEA. The midterm functional outcomes are satisfactory with no revisions required, despite a relatively high rate of complications. Further long-term studies with larger cohorts are needed to better elucidate long-term outcomes and reasons for failure. Level of evidenceIV; therapeutic study (case series [no, or historical, control group])