Revision in Total Elbow Replacement with Bone Stock Loss: Surgical Technique and Expected Results

Mobilizations of total elbow arthroplasties are fairly infrequent conditions, but elbow prosthesis revision, especially in case of bone loss, is very demanding. There is necessity of multiple surgical equipments, grafts, and dedicated instruments. On the other side, procrastinating the surgery exposes the risk of further bone loss, worsening muscle atrophy and increasing the risk of fracture. It is essential to understand the mechanism of failure of a prosthetic implant, immediately distinguishing between failures due to an underlying infection and those due to an aseptic loosening, or a periprosthetic fracture. Aseptic loosening is the most frequent cause of failure. The choice of the type of surgery should be guided by the size and location of loss of bone substance. In any case the use of a graft is mandatory in prosthetic revisions with loss of bone stock, mainly because the graft increases the bone stock, helps to bridge bone defects, and provides temporary structural support for implant stability.