Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

Purpose: This study reports our experience with revision total elbow arthroplasty by exchange cementation, describes a classification system to define qualitative diaphyseal bone loss and correlates bone quality with revision outcome.

Material and Methods: Fifty five elbows (54 patients) underwent revision cementation into the existing cement mantle or débrided bone interface, without structural bone graft, custom prosthesis or prosthetic augmentation. Indications were aseptic loosening (29), infection (16) and instability for unlinked device (8).

Results: Mean follow-up was 85.4 months (27 to 266 months) ; 14 patients had died, all with the prosthesis in situ at mean 124 months (22-190). Clinical results were satisfactory according to the Mayo Elbow Performance Score in 72% of elbows. Complications occurred in 32 elbows (59%). Re-operation was performed in 20 elbows (36%) including 11 (20%) component re-revisions, for aseptic loosening in 7 (mean 56.9 months) and 2 each of prosthetic fracture and sepsis. Loosening occurred around 2 humeral (3.7%) and 8 ulnar components (14.8%). There were no failures in 16 elbows with ulnar defects that were bridged by an implant that bypassed the bony deficiencies by two cortical diameters. Of note, there was a statistically significant higher failure rate (P<.01) in those with moderate osseous deficiency that were not adequately addressed.

Conclusion: Recementation is a successful technique for revision elbow arthroplasty if key requirements for adequate bone stock and stem fixation are met. The proposed classification identifies the critical threshold of bone stock associated with successful revision and provides a preoperative strategy to predict the need for stem extension beyond defects.