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