Cadaveric elbow allografts. A six-year experience.
Transplantation of total elbow allografts has been employed as a salvage procedure in an attempt to provide patients with a useful, painless range of motion of the elbow. Patients who are candidates for this procedure include those with disabling elbow joint symptoms who refuse an arthrodesis or are not candidates for conventional total elbow replacement because of excessive bone loss or young age. Allografts must be subjected to rigid internal fixation. Rush rod fixation used early in this series was associated with a high incidence of nonunion. In this series, ten patients followed for one to six years were provided with a functional elbow. However, long-term results are still unknown. Although not recommended for routine use, this operation is viewed as a salvage procedure. The use of allografts in elbow reconstruction does not preclude subsequent reconstruction with another allograft or fusion. In patients with deficient bone stock, the allografts reestablish bone mass to permit an arthrodesis or reconstructive arthroplasty.
Available from: Pierre Mansat
- "Because of these elements and when the joint space has disappeared completely, total elbow arthroplasty is sometimes the only available option to restore satisfactory range of motion. In certain cases of post-traumatic arthritis, the therapeutic options include distraction with interposition arthroplasty  , and arthrodesis    . In certain cases of non-union of the distal humerus in which the joint space is preserved, internal fixation with a bone graft can be proposed    . "
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ABSTRACT: Traumatic sequelae of the elbow are difficult to manage because of bone deformities, changes in joint congruency and bone defects.
Total elbow arthroplasty is a therapeutic option when the joint space has disappeared. Nineteen patients underwent semi-constrained Coonrad-Morrey(®) total elbow arthroplasty in 12 cases for post-traumatic elbow arthritis (group 1) and in seven cases for 7 non-union of the distal humerus (group 2). The mean age at surgery was 60years old (56 in group 1 and 67 in group 2). The mean delay between the initial trauma and arthroplasty was 16years (group 1) and 22months (group 2).
At a mean follow-up of 5.5years (24-156months) in group 1, the Quick-DASH score was 34 points with outcomes that were considered to be good to excellent in 75% of the cases according to the Mayo Elbow Performance Score (MEPS). A progressive radiolucency was identified on X-ray in 33% of the cases, and moderate wear of the polyethylene insert in 17%. There were 7 complications (58%) requiring revision in 3 cases (25%). At a mean follow-up of 4.6years (24-108months) in group 2, the Quick-DASH score was 39 points with good and excellent results in 86% according to the MEPS. A radiolucency was noted in 28% and moderate wear of the inserts in 14%. There were 2 complications (28%) requiring revision in 1 case (14%).
Semi-constrained total elbow arthroplasties provide recovery of functional range of motion with a stable and pain-free elbow for post-traumatic conditions. The age at surgery is a risk factor for complications. The indication for total elbow arthroplasty in patients under 60 should be carefully considered in relation to alternative treatment options.
Level IV Retrospective study.
Orthopaedics & Traumatology Surgery & Research 12/2013; 100(1). DOI:10.1016/j.otsr.2013.10.012 · 1.26 Impact Factor
Available from: Marwan El-Rich
- "However, when a coronoid is severely comminuted, autogenous bone graft may be necessary to restore the structural integrity of the coronoid (Chung et al., 2007; Urbaniak and Black, 1985; van Riet et al., 2005). There are also many reports of using osteochondral allograft in cases of bone loss in intra-articular elbow fractures (Breen et al., 1988; Dean et al., 1997; Jerosch et al., 2002; Urbaniak and Black, 1985). Clinical Biomechanics 28 (2013) 626–634 ⁎ Corresponding author at: 3-016, Markin/CNRL NREF, Edmonton, Alberta T6G 2W2, "
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The proximal tibiofibular joint can be used as a source of osteochondral autograft with little to no morbidity at the harvest site.
CT scans of fourteen left and seven right fibular heads, seven right and six left ulnas obtained from healthy subjects were volume-scaled and analyzed. Ipsilateral ulnar articular surfaces were compared between subjects and contralateral ulnas were compared within the same subject. The average deviations between the surfaces were measured. Manual registration and best-fit alignment were used to locate the area on the fibular heads that would best-fit the 50% coronoid process surface.
The average deviations in the articular surface between subjects were (mean (SD) 0.79mm (0.17) and 0.76mm (0.14) for the left and right ulnas respectively and 0.35mm (0.07) in the same subject. The average coronoid process height of the scaled ulnas was 15.92mm (1.15). When comparing the 50% coronoid process with the ispsilateral fibular head geometries, the maximum deviations for all subjects were smaller than 2.0mm. Two locations were identified as the best-fit locations.
When volume-scaled, the articular congruency of the proximal ulna articular surfaces between subjects is within the allowable limit for a typical intra-articular fracture step. Results suggest it is possible to use the CT scan of a patient's contralateral elbow as a template to estimate the morphology of the affected side. The fibular head could be an alternative replacement for damaged coronoid process since it is covered by articular cartilage and has locations with a similar curvature as the coronoid process.
Clinical biomechanics (Bristol, Avon) 06/2013; 28(6). DOI:10.1016/j.clinbiomech.2013.05.004 · 1.97 Impact Factor
Available from: Catherine A Kusnick
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ABSTRACT: The radiographic features of 41 cadaveric osteochondral shell (low ratio of subchondral bone to articular cartilage) allografts placed in 24 patients for articular resurfacing as an alternative to arthroplasty are presented. Underlying causes of joint disease included ischemic necrosis (20 grafts), osteochondritis dissecans (nine), chondromalacia patellae (10), and posttraumatic osteochondral fracture with degenerative disease (two). Congruity with the adjacent native articular surface and the opposite side of the joint was evident on immediate postoperative radiographs in all patients, and proved to be critical to the ultimate success of the procedure. On follow-up radiographs over a period of 2-28 months, successful incorporation of the allograft was characterized by progressive loss of the relative increased density of the graft, in association with diminished lucency related to new bone formation at the graft-native bone interface, as well as maintained alignment. Graft failure was associated with positional changes including collapse, persistent increased density, and poorly defined fragmentation that occasionally simulated infection radiographically and resulted in intraarticular bodies. Resurfacing of diseased articulations with osteochondral shell allografts constitutes a potentially desirable alternative to total joint arthroplasty, particularly among younger patients. Consequently, an awareness of the expected radiographic alterations associated with graft incorporation and failure is important.
American Journal of Roentgenology 11/1987; 149(4):743-8. DOI:10.2214/ajr.149.4.743 · 2.73 Impact Factor
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