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Journal of Shoulder and Elbow Surgery

Outcomes following revision of the revision total elbow arthroplasty

Published:November 18, 2020DOI:https://doi.org/10.1016/j.jse.2020.10.016

      Background

      There is very little information in the literature on the outcomes of revision of revision total elbow arthroplasty (RRTEA). Our aim was to report the outcomes of this rarely performed procedure.

      Methods

      We retrospectively identified all patients who had undergone RRTEA between 2007 and 2016. Outcomes were assessed clinically using a number of validated systems, and radiographs were reviewed for prosthesis alignment, cementation by Morrey grading, and heterotopic ossification.

      Results

      We identified 22 patients who underwent RRTEA. Of these patients, 14 were available for assessment (2 died of unrelated causes, 2 could not be contacted, 2 declined to participate because of travel difficulties, and 2 had incomplete data). At the final review, the median age was 73 years (range, 57-83 years), with a median follow-up period of 4.5 years (range, 2-7 years) since the last surgical procedure. The median number of previous revision arthroplasty procedures per patient was 3 (range, 2-6). The indications for RRTEA were aseptic loosening (60%), bushing wear (16%), fracture (14%), and infection (10%). Of the patients, 30% required extra-long or custom-made implants and 50% needed allograft augmentation. At final clinical assessment, 56% of patients had triceps insufficiency, the median flexion-extension arc was 90°, and the median prono-supination arc was 95°. The functional elbow scores revealed good outcomes in the majority of patients (median visual analog scale score, 5; median Oxford Elbow Score, 22; median Mayo Elbow Performance Index score, 55; and median QuickDASH [short version of Disabilities of the Arm, Shoulder and Hand questionnaire] score, 63). Eighty-one percent of patients were satisfied with their RRTEAs. Complications included infection in 2 patients (1 superficial and 1 deep), symptomatic aseptic humeral component loosening in 1, sensory ulnar nerve symptoms in 2, and radial nerve injury in 1. One patient required ulnar nerve release. Radiologic review revealed asymptomatic loosening in 1 patient (humeral component), and overall prosthesis alignment with cementation was adequate in 81%. Heterotopic ossification was present in 38% of cases.

      Conclusions

      RRTEA is a satisfactory treatment option in these complex cases, with good short- to mid-term survival rates but a relatively high complication rate.

      Level of evidence

      Keywords

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      References

        • Aldridge J.M.
        • Lightdale N.R.
        • Mallon W.J.
        • Coonrad R.W.
        Total elbow arthroplasty with the Coonrad/Coonrad-Morrey prosthesis: a 10- to 31-year survival analysis.
        J Bone Joint Surg Br. 2006; 88: 509-514https://doi.org/10.1302/0301-620X.88B4.17095
        • Amirfeyz R.
        • Stanley D.
        Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss: a medium-term follow-up.
        J Bone Joint Surg Br. 2011; 93: 1382-1388https://doi.org/10.1302/0301-620X.93B10.26729
        • Athwal G.S.
        • Morrey B.F.
        Revision total elbow arthroplasty for prosthetic fractures.
        J Bone Joint Surg Am. 2006; 88: 2017-2026https://doi.org/10.2106/JBJS.E.00878
        • Dalemans A.
        • De Smet L.
        • Degreef I.
        Long-term outcome of elbow resurfacing.
        J Shoulder Elbow Surg. 2013; 22: 1455-1460https://doi.org/10.1016/j.jse.2013.06.013
        • Dee R.
        Total replacement arthroplasty of the elbow for rheumatoid arthritis.
        J Bone Joint Surg Br. 1972; 54: 88-95
        • Ferlic D.C.
        • Clayton M.L.
        Salvage of failed total elbow arthroplasty.
        J Shoulder Elbow Surg. 1995; 4: 290-297
        • Fevang B.T.S.
        • Lie S.A.
        • Havelin L.I.
        • Skredderstuen A.
        • Furnes O.
        Results after 562 total elbow replacements: a report from the Norwegian arthroplasty register.
        J Shoulder Elbow Surg. 2009; 18: 449-456https://doi.org/10.1016/j.jse.2009.02.020
        • Geurts E.J.
        • Viveen J.
        • van Riet R.P.
        • Kodde I.F.
        • Eygendaal D.
        Outcomes after revision total elbow arthroplasty: a systematic review.
        J Shoulder Elbow Surg. 2019; 28: 381-386https://doi.org/10.1016/j.jse.2018.08.024
        • Gill D.R.
        • Morrey B.F.
        The Coonrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year follow-up study.
        J Bone Joint Surg Am. 1998; 80: 1327-1335
        • Gschwend N.
        • Simmen B.R.
        • Matejovsky Z.
        Late complications in elbow arthroplasty.
        J Shoulder Elbow Surg. 1996; 5: 86-96
        • Kaufmann R.A.
        • D'Auria J.L.
        • Schneppendahl J.
        Total elbow arthroplasty: elbow biomechanics and failure.
        J Hand Surg Am. 2019; 44: 687-692https://doi.org/10.1016/j.jhsa.2018.11.020
        • Kim J.M.
        • Mudgal C.S.
        • Konopka J.F.
        • Jupiter J.B.
        Complications of total elbow arthroplasty.
        J Am Acad Orthop Surg. 2011; 19: 328-339https://doi.org/10.5435/00124635-201106000-00003
        • King G.J.
        • Adams R.A.
        • Morrey B.F.
        Total elbow arthroplasty: revision with use of a non-custom semiconstrained prosthesis.
        J Bone Joint Surg Am. 1997; 79: 394-400
        • Klug A.
        • Gramlich Y.
        • Buckup J.
        • Schweigkofler U.
        • Hoffmann R.
        • Schmidt-Horlohé K.
        Trends in total elbow arthroplasty: a nationwide analysis in Germany from 2005 to 2014.
        Int Orthop. 2018; 42: 883-889https://doi.org/10.1007/s00264-018-3818-x
        • Kraay M.J.
        • Figgie M.P.
        • Inglis A.E.
        • Wolfe S.W.
        • Ranawat C.S.
        Primary semiconstrained total elbow arthroplasty. Survival analysis of 113 consecutive cases.
        J Bone Joint Surg Br. 1994; 76: 636-640
        • Krukhaug Y.
        • Hallan G.
        • Dybvik E.
        • Lie S.A.
        • Furnes O.N.
        A survivorship study of 838 total elbow replacements: a report from the Norwegian arthroplasty register 1994-2016.
        J Shoulder Elbow Surg. 2018; 27: 260-269https://doi.org/10.1016/j.jse.2017.10.018
        • Kwak J.M.
        • Kholinne E.
        • Sun Y.
        • Kim M.S.
        • Koh K.H.
        • Jeon I.H.
        Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty.
        Int Orthop. 2019; 43: 1421-1427https://doi.org/10.1007/s00264-018-4267-2
        • Little C.P.
        • Graham A.J.
        • Carr A.J.
        Total elbow arthroplasty: a systematic review of the literature.
        J Bone Joint Surg Br. 2005; 87: 437-444https://doi.org/10.1302/0301-620X.87B4.15692
        • Lue E.Y.
        • Hildebrand A.
        • Horner N.S.
        • Athwal G.S.
        • Alolabi B.
        Heterotopic ossification after total elbow arthroplasty: a systematic review.
        J Shoulder Elbow Surg. 2019; 28: 587-595https://doi.org/10.1016/j.jse.2018.10.003
        • Mansat P.
        • Bonnevialle N.
        • Rongieres M.
        • Mansat M.
        • Bonnevialle P.
        • French Society for Shoulder and Elbow SOFEC
        Results with a minimum of 10 years follow-up of the Coonrad/Morrey total elbow arthroplasty.
        Orthop Traumatol Surg Res. 2013; 99: 337-343https://doi.org/10.1016/j.otsr.2013.07.002
        • Morrey B.
        • Bryan R.
        • Dobyns J.
        • Linscheid R.
        Total elbow arthroplasty. A five-year experience at the Mayo Clinic.
        J Bone Joint Surg Am. 1981; 63: 1050-1063
        • Morrey M.E.
        • Sanchez-Sotelo J.
        • Abdel M.P.
        • Morrey B.F.
        Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty.
        J Bone Joint Surg Am. 2013; 95: 1117-1124https://doi.org/10.2106/JBJS.L.00747
        • Park S.E.
        • Kim J.Y.
        • Cho S.W.
        • Rhee S.K.
        • Kwon S.Y.
        Complications and revision rate compared by type of total elbow arthroplasty.
        J Shoulder Elbow Surg. 2013; 22: 1121-1127https://doi.org/10.1016/j.jse.2013.03.003
        • Peach C.A.
        • Nicoletti S.
        • Lawrence T.M.
        • Stanley D.
        Two-stage revision for the treatment of the infected total elbow arthroplasty.
        Bone Joint J. 2013; 95-B: 1681-1686https://doi.org/10.1302/0301-620X.95B12.31336
        • Pham T.T.
        • Delclaux S.
        • Huguet S.
        • Wargny M.
        • Bonnevialle N.
        • Mansat P.
        Coonrad-Morrey total elbow arthroplasty for patients with rheumatoid arthritis: 54 prostheses reviewed at 7 years' average follow-up (maximum 16 years).
        J Shoulder Elbow Surg. 2018; 27: 398-403https://doi.org/10.1016/j.jse.2017.11.007
        • Plaschke H.C.
        • Thillemann T.M.
        • Brorson S.
        • Olsen B.S.
        Outcome after total elbow arthroplasty: a retrospective study of 167 procedures performed from 1981 to 2008.
        J Shoulder Elbow Surg. 2015; 24: 1982-1990https://doi.org/10.1016/j.jse.2015.07.036
        • Pooley J.
        Total elbow replacement—patient selection and perspectives.
        Orthop Res Rev. 2019; 25: 23-40https://doi.org/10.2147/ORR.S134719
        • Prasad N.
        • Ali A.
        • Stanley D.
        Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus: a minimum ten-year follow-up.
        Bone Joint J. 2016; 98-B: 381-386https://doi.org/10.1302/0301-620X.98B3.35508
        • Ramirez M.A.
        • Cheung E.V.
        • Murthi A.M.
        Revision total elbow arthroplasty.
        J Am Acad Orthop Surg. 2017; 25: 166-174https://doi.org/10.5435/JAAOS-D-15-00479
        • Robinson P.M.
        • MacInnes S.J.
        • Stanley D.
        • Ali A.A.
        Heterotopic ossification following total elbow arthroplasty: a comparison of the incidence following elective and trauma surgery.
        Bone Joint J. 2018; 100-B: 767-771https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-0535.R2
        • Schneeberger A.G.
        • Meyer D.C.
        • Yian E.H.
        Coonrad-Morrey total elbow replacement for primary and revision surgery: a 2- to 7.5-year follow-up study.
        J Shoulder Elbow Surg. 2007; 16: 47-54https://doi.org/10.1016/j.jse.2006.01.013
        • Schöni M.
        • Drerup S.
        • Angst F.
        • Kyburz D.
        • Simmen B.
        • Goldhahn J.
        Long-term survival of GSB III elbow prostheses and risk factors for revisions.
        Arch Orthop Trauma Surg. 2013; 133: 1415-1424https://doi.org/10.1007/s00402-013-1815-5
        • Shahane S.A.
        • Stanley D.
        A posterior approach to the elbow joint.
        J Bone Joint Surg Br. 1999; 81: 1020-1022
        • Shi L.L.
        • Zurakowski D.
        • Jones D.G.
        • Koris M.J.
        • Thornhill T.S.
        Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis.
        J Bone Joint Surg Am. 2007; 89: 1467-1475https://doi.org/10.2106/JBJS.F.00715
        • Sneftrup S.B.
        • Jensen S.L.
        • Johannsen H.V.
        • Søjbjerg J.O.
        Revision of failed total elbow arthroplasty with use of a linked implant.
        J Bone Joint Surg Br. 2006; 88: 78-83https://doi.org/10.1302/0301-620X.88B1.16446
        • Vergidis P.
        • Greenwood-Quaintance K.E.
        • Sanchez-Sotelo J.
        • Morrey B.F.
        • Steinmann S.P.
        • Karau M.J.
        • et al.
        Implant sonication for the diagnosis of prosthetic elbow infection.
        J Shoulder Elbow Surg. 2011; 20: 1275-1281https://doi.org/10.1016/j.jse.2011.06.016
        • Viveen J.
        • Prkic A.
        • Koenraadt K.L.
        • Kodde I.F.
        • Eygendaal D.
        Clinical and radiographic outcome of revision surgery of total elbow prosthesis: midterm results in 19 cases.
        J Shoulder Elbow Surg. 2017; 26: 716-722https://doi.org/10.1016/j.jse.2016.10.010
        • Voloshin I.
        • Schippert D.W.
        • Kakar S.
        • Kaye E.K.
        • Morrey B.F.
        Complications of total elbow replacement: a systematic review.
        J Shoulder Elbow Surg. 2011; 20: 158-168https://doi.org/10.1016/j.jse.2010.08.026