title: Impaction grafting in revision total elbow arthroplasty due to aseptic loosening and bone loss.
abstract: BACKGROUND
  With the increase in the number of total elbow arthroplasties being performed, there has been a parallel increase in revision surgery. There is limited information about the outcome of impaction grafting following failed elbow arthroplasty.
  
  
  METHODS
  We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of a semiconstrained total elbow replacement. There were three men and thirteen women with a mean age of 58.4 years (range, twenty-eight to seventy-five years). Fourteen elbows had loosening of both the humeral and the ulnar component, and two elbows had only humeral loosening. Two elbows had perforation of the humeral cortex by the humeral component, and one had perforation of the ulnar cortex. Grade-II bone loss as described by King et al. was found in three elbows; grade III, in six elbows; and grade IV, in seven elbows. The impaction grafting was performed with only allograft in thirteen elbows, and it was done with allograft as well as autograft from the iliac crest in the other three elbows. The mean duration of follow-up was 7.4 years (range, 4.1 to 11.2 years).
  
  
  RESULTS
  The mean Mayo Elbow Performance Score (MEPS) for pain significantly improved from 15.0 points preoperatively to 32.8 points at the time of latest follow-up (p = 0.003). The mean arc of flexion also significantly increased, from 60.3° to 115.6° (p &lt; 0.01). Stability according to the MEPS significantly increased from a mean of 2.2 points to a mean of 9.4 points (p = 0.001). The mean total MEPS improved from 41.0 points to 82.8 points (p = 0.001). The result was excellent for four elbows, good for eleven, and fair for one. Follow-up radiographs demonstrated fifteen cases with grade-I resorption of the bone graft and one case with grade-II resorption. A type-I radiolucent line was observed in twelve of the elbows; type II, in three; and type IV, in one. Additional surgery was required in two cases.
  
  
  CONCLUSIONS
  Impaction grafting is an effective technique when revision total elbow arthroplasty is used for the treatment of aseptic loosening with bone loss.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, South Korea. shoulderrhee@hanmail.net
authors.forename: Yong Girl
authors.initials: YG
authors.lastname: Rhee
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Cho
authors.forename: Chong Suck
authors.initials: CS
authors.lastname: Parke
mesh_terms: D000328:Adult; D000368:Aged; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome