While a rare procedure, revision of revision of total elbow arthroplasty can offer satisfactory outcomes, but with a relatively high complication rate, researchers found.
Revision of Revision Elbow Arthroplasty: New Outcome Data
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“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,” they wrote in “Outcomes Following Revision of the Revision Total Elbow Arthroplasty,” published November 18, 2020 online in the Journal of Shoulder and Elbow Surgery.
For their study, they retrospectively identified all the patients who had undergone revision of revision of total elbow arthroplasty between 2007 and 2016. There were 22 patients in total, but only 14 were available for assessment. The median age was 73 (57-83) years with a median follow-up of 4.5 (2-7) years since the last surgery.
The indications for the additional revision were aseptic loosening (60%), bushing wear (16%), fracture (14%) and infection (10%). Thirty percent of the patients needed extra-long or custom-made implants and half of the patients required allograft augmentation.
The researchers wrote, “At final clinical assessment 56% had triceps insufficiency, media 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).”
Overall, 81% of the patients were satisfied with their RRTEA. Eighty-one percent of patients also reported adequate prosthesis alignment with cementation.
The complications reported were infection (one superficial, one deep), one symptomatic aseptic humeral component loosening, two patients with sensory ulna nerve symptoms, one patient with radial nerve injury.
One of the patients needed ulna nerve release. And one patient had asymptomatic loosening.
Thirty-eight percent of the patients experienced heterotrophic ossification, abnormal bone growth in muscles, tendons or other soft tissues.
The researchers concluded that revision of revision of total elbow arthroplasty “is a satisfactory treatment option in these complex cases with good short to mid-term survival rates, but with a relatively high complication rate.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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