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Impaction Grafting in Revision Total Elbow Arthroplasty
Mark I. Loebenberg, MD1; Robert Adams, MA, RPA2; Shawn W. O'Driscoll, PhD, MD2; Bernard F. Morrey, MD2
1 Shoulder and Elbow Service, New York University/Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003
2 Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. B.F. Morrey received royalties with the Coonrad-Morrey total elbow arthroplasty. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jan 01;87(1):99-106. doi: 10.2106/JBJS.B.00038
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Background: Revision total elbow arthroplasty is often undertaken in patients who have severe osteolysis of both the distal part of the humerus and the proximal part of the ulna. To deal with such bone loss, we have adopted the practice of impaction grafting, which has become a well-established technique in the proximal part of the femur.

Methods: We retrospectively reviewed the results of twelve patients who had undergone revision total elbow arthroplasty with impaction grafting between 1993 and 1997. There were eight women and four men with a mean age of fifty-seven years. All patients were followed for at least two years (range, twenty-five to 113 months), with an average duration of follow-up of seventy-two months. Seven of the patients had an initial diagnosis of rheumatoid arthritis, and five had posttraumatic arthritis. Impaction grafting was undertaken during the initial revision in three of the patients, whereas the remaining nine patients had undergone at least one prior revision without impaction grafting. Four patients had impaction grafting on the ulnar side alone, six had it on the humeral side alone, and two underwent impaction grafting of both the humerus and the ulna. Six allograft struts were placed to span structural defects in five patients.

Results: At the time of the latest follow-up, eight of the elbow prostheses were intact after the index impaction grafting procedure. Two elbows had been revised because of loosening, and another had been revised because of a fracture of the ulnar component. A fourth patient had undergone a resection arthroplasty because of infection. The eight remaining patients demonstrated marked radiographic improvement in bone quality in the region of the impaction graft without clinical symptoms of loosening. At the time of the last follow-up, after an additional revision in three elbows, there were five excellent, four good, and three fair results.

Conclusions: Impaction grafting is a reliable technique for treating osteolysis in patients undergoing revision total elbow arthroplasty; however, complications can occur, and a high percentage of patients need additional surgery.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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