There is very little 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.
Retrospective identification of 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 heterotrophic ossification (HO).
Twenty-two patients were identified as having RRTEA. Fourteen patients were available for assessment (2 died from unrelated causes, 2 were uncontactable, 2 declined due to travel difficulties and 2 had incomplete data). At the final review the median age was 73 (57-83) years with a median follow-up of 4.5 (2-7) years since the last surgery. Median number of previous revision arthroplasty procedures per patient was 3 (2-6). Indications for RRTEA: aseptic loosening (60%), bushing wear (16%), fracture (14%) and infection (10%). 30% required extra-long or custom-made implants and 50% needed allograft augmentation. At final clinical assessment 56% had triceps insufficiency, median flexion-extension arc was 90 degrees and median prono-supination was 95 degrees. The functional elbow scores revealed good outcomes in the majority (median scores: VAS 5, OES 22, MEPI 55, QuickDash 63). 81% were satisfied with their RRTEA. Complications included infection in 2 (1 superficial, 1 deep), symptomatic aseptic humeral component loosening in 1, sensory ulna nerve symptoms in 2, radial nerve injury in 1. One patient required ulna nerve release. Radiological review revealed asymptomatic loosening in 1 patient (humeral component) and overall prosthesis alignment with cementation was adequate in 81%. HO was present in 38% of cases.
RRTEA is a satisfactory treatment option in these complex cases with good short to mid-term survival rates but with a relatively high complication rate.
Level IV; Case Series; Treatment Study.
Copyright © 2020. Published by Elsevier Inc.