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Saturday, March 18, 2000

TEA with composite allografts aids failed elbow arthroplasty

Total elbow arthroplasty (TEA) with massive composite allografts of the distal humerus and/or proximal ulna is a worthwhile treatment option for the difficult problem of failed elbow arthroplasty or humeral fractures/non-unions with extensive bone loss, according to a study presented in poster exhibit 339.

Kevin Renfree, MD, senior associate consultant, hand and upper extremity surgery, Mayo Clinic, Scottsdale, Ariz., presented the study that included 10 patients with an average follow up of 6.5 years (range, 2 to 10.6 years). Seven women and three men, with an average age of 58 years (range, 45 to 72 years), had the following diagnosis: failed (or multiply failed) TEA (N=5), non-union or supracondylar humerus fracture (N=3), post traumatic arthritis and instability (N=I), and bone loss from infection (N=I). There were numerous surgical procedures done prior to the initial allograft revision (average N=3, range 1 to 8) and postoperatively (average N=2, range 0 to 12). The usual indications for surgery were pain, instability, prosthetic loosening and sequelae from infection.

At final follow up, six patients had no, or mild pain; three, moderate pain; and one, severe pain. Six patients had no, or mild instability; two moderate instability; and two, severe instability. In terms of function, three had slight restrictions of activities of daily living; one was unable to lift greater than 10 pounds. Three were unable to comb hair, and three were unable to feed themselves. Range of motion in the flexion/extension arc averaged 79 degrees (range 0 to 135 degrees).

Using the Morrey-Bryan evaluation system there were three good (satisfactory), five fair, and two poor results. Using the Hospital for Special Surgery evaluation system, which includes functional assessment, there was one excellent, two good, one fair, three poor and three failed results. One deep infection occurred postoperatively, and triceps insufficiency or weakness was a significant problem (N=8). Radiographically, healing was noted at the host/graft junction in seven humeral and five ulnar allografts. Three non-unions occurred, all with ulnar allografts (one in association with a deep postoperative infection). Three outright failures occurred, two of which have been revised in the past year, and another patient with loosening of the humeral component within a healed humeral allograft, declined further surgery.

The researchers said the study showed this is a worth-while treatment option. They observed that pain relief and restoration of stability were reasonably good, but functional return is limited. In terms of subjective patient satisfaction, six patients believed they achieved a good result; one, a fair result; and three poor results. An 86 percent healing rate was noted at the host-allograft junction.

Co-authors of the study are Thomas Wright, MD, assistant professor, section of hand and microsurgery, and Paul C. Dell, MD, professor, department of orthopaedic surgery, chief section of hand and microsurgery, both of the University of Florida, Gainesvile, Fla.; and Scott H. Kozin, MD, assistant professor, department of orthopaedic surgery; Temple University, Philadelphia.

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2000 Academy News March 18 Index B

Last modified 18/March/2000 by IS