BACKGROUND
Primary total elbow replacement (TER) survival analysis has demonstrated a higher prosthesis revision percentage for all causes, 13% at 5 years, than total hip replacement.1 This means that although fewer TERs are undertaken, there is still a heavy revision burden. The reported complications for revision TER include fracture during cement removal, related to difficulty with access because of the narrow medullary canal and often secondary to poor bone stock because of osteolysis.2 This technical note presents a novel aid for easier cement removal from the humerus and ulna which has been used in 10 patients undergoing revision TER.
TECHNIQUE
Patient positioning, preparation, approach and prosthesis removal was undertaken using the surgeon's standard technique. The visible loose cement was removed from the humerus and ulna. A standard 30° 5-mm arthroscope (Linvatec, Largo, FL, USA) was then introduced into the medullary canal. Under direct vision, the cement plug was breached distally using a high speed burr (5-mm head and 8-cm long). The remaining cement was burred loose from the bone. The boundary between cortical bone and cement is easily visualised during the burring procedure (Fig. 1). Remaining cement can be removed using a combination of irrigation and an arthroscopic grabber under direct vision. Once the cement had been removed, the revision was completed routinely.
Figure 1.
Intra-operative arthroscopic photograph of cement burring in the medullary canal of the ulna.
DISCUSSION
Revision elbow replacement is a complex procedure associated with high rates of complications.2 The technique described above has proved, in a limited number of patients, to be a safe and useful method of cement removal.
References
- 1.Little CP, Graham AJ, Carr AJ. Total elbow arthroplasty a systemic review of the literature in the English language up until the end of 2003. J Bone Joint Surg Br. 2005;87:437–44. doi: 10.1302/0301-620X.87B4.15692. [DOI] [PubMed] [Google Scholar]
- 2.Kamineni S, Morrey BF. Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty. J Bone Joint Surg Am. 2004;86:1223–9. doi: 10.2106/00004623-200406000-00015. [DOI] [PubMed] [Google Scholar]