Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock
Background: Severe humeral bone loss in the setting of failed total elbow arthroplasty (TEA) poses a particularly challenging reconstructive problem. The objective of this study was to review the rationale, indications, contraindications, and detailed surgical technique for using an extended anterio...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | JSES Reviews, Reports, and Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666639122001201 |
| _version_ | 1797837734966984704 |
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| author | Adnan N. Cheema, MD Jacob J. Triplet, DO Mark E. Morrey, MD Joaquín Sanchez-Sotelo, MD, PhD |
| author_facet | Adnan N. Cheema, MD Jacob J. Triplet, DO Mark E. Morrey, MD Joaquín Sanchez-Sotelo, MD, PhD |
| author_sort | Adnan N. Cheema, MD |
| collection | DOAJ |
| description | Background: Severe humeral bone loss in the setting of failed total elbow arthroplasty (TEA) poses a particularly challenging reconstructive problem. The objective of this study was to review the rationale, indications, contraindications, and detailed surgical technique for using an extended anterior deltopectoral approach to perform a revision TEA when substantially long allografts are required in the presence of severely compromised proximal humerus bone stock. Methods: The authors developed this exposure and reconstructive strategy for failed elbow arthroplasties where the remaining segment of proximal humerus is extremely short, which makes adequate plate fixation of an allograft-prosthetic composite (APC) to the native bone extremely challenging. From an anterior deltopectoral approach, it is possible to use dedicated long, precontoured proximal humerus locking plates to maximize fixation in any remaining proximal humerus. This exposure still makes it possible to provide adequate access to the coupling mechanism of the humeral and ulnar components for implantation of a linked elbow arthroplasty. This exposure also allows for adequate judgment of humeral length and rotation. Pitfalls and Challenges: Crucial steps in the surgery include extending the dissection past the elbow flexion crease such that one can obtain circumferential exposure of the distal humerus. It is also important to couple the humeral and ulnar components prior to committing to the length of the APC. Special attention must be paid to gauge appropriate APC rotation and length for proper soft tissue tension. When performing fixation of the proximal humeral plate, screw purchase must be maximized in both the remaining native proximal humerus and the APC. Compression across the allograft-host interface is paramount for healing to occur. Conclusion: An extended anterior deltopectoral approach to perform a revision TEA when very long APCs are required is a viable option to restore humeral bone stock and regain humeral stem fixation in the setting of failed TEA with extensive humeral bone loss. |
| first_indexed | 2024-04-09T15:30:34Z |
| format | Article |
| id | doaj.art-d58358547b5046689a87980bc7318aae |
| institution | Directory Open Access Journal |
| issn | 2666-6391 |
| language | English |
| last_indexed | 2024-04-09T15:30:34Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES Reviews, Reports, and Techniques |
| spelling | doaj.art-d58358547b5046689a87980bc7318aae2023-04-28T08:56:36ZengElsevierJSES Reviews, Reports, and Techniques2666-63912023-05-0132209214Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stockAdnan N. Cheema, MD0Jacob J. Triplet, DO1Mark E. Morrey, MD2Joaquín Sanchez-Sotelo, MD, PhD3Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USADivision of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USADivision of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USACorresponding author: Joaquín Sanchez-Sotelo, MD, PhD, Mayo Clinic, 200 First St SW, Rochester, MN 55901, USA.; Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USABackground: Severe humeral bone loss in the setting of failed total elbow arthroplasty (TEA) poses a particularly challenging reconstructive problem. The objective of this study was to review the rationale, indications, contraindications, and detailed surgical technique for using an extended anterior deltopectoral approach to perform a revision TEA when substantially long allografts are required in the presence of severely compromised proximal humerus bone stock. Methods: The authors developed this exposure and reconstructive strategy for failed elbow arthroplasties where the remaining segment of proximal humerus is extremely short, which makes adequate plate fixation of an allograft-prosthetic composite (APC) to the native bone extremely challenging. From an anterior deltopectoral approach, it is possible to use dedicated long, precontoured proximal humerus locking plates to maximize fixation in any remaining proximal humerus. This exposure still makes it possible to provide adequate access to the coupling mechanism of the humeral and ulnar components for implantation of a linked elbow arthroplasty. This exposure also allows for adequate judgment of humeral length and rotation. Pitfalls and Challenges: Crucial steps in the surgery include extending the dissection past the elbow flexion crease such that one can obtain circumferential exposure of the distal humerus. It is also important to couple the humeral and ulnar components prior to committing to the length of the APC. Special attention must be paid to gauge appropriate APC rotation and length for proper soft tissue tension. When performing fixation of the proximal humeral plate, screw purchase must be maximized in both the remaining native proximal humerus and the APC. Compression across the allograft-host interface is paramount for healing to occur. Conclusion: An extended anterior deltopectoral approach to perform a revision TEA when very long APCs are required is a viable option to restore humeral bone stock and regain humeral stem fixation in the setting of failed TEA with extensive humeral bone loss.http://www.sciencedirect.com/science/article/pii/S2666639122001201Anterior approachRevision total elbowHumeral allograft-prosthetic compositePeriprosthetic humeral fracture |
| spellingShingle | Adnan N. Cheema, MD Jacob J. Triplet, DO Mark E. Morrey, MD Joaquín Sanchez-Sotelo, MD, PhD Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock JSES Reviews, Reports, and Techniques Anterior approach Revision total elbow Humeral allograft-prosthetic composite Periprosthetic humeral fracture |
| title | Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock |
| title_full | Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock |
| title_fullStr | Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock |
| title_full_unstemmed | Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock |
| title_short | Extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft-prosthetic composites in patients with severely compromised proximal humerus bone stock |
| title_sort | extended deltopectoral approach for revision total elbow arthroplasty requiring humeral allograft prosthetic composites in patients with severely compromised proximal humerus bone stock |
| topic | Anterior approach Revision total elbow Humeral allograft-prosthetic composite Periprosthetic humeral fracture |
| url | http://www.sciencedirect.com/science/article/pii/S2666639122001201 |
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