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. 2023 Aug 10;6(1):91-97.
doi: 10.1016/j.jhsg.2023.07.003. eCollection 2024 Jan.

Elbow Uncemented Hemiarthroplasty: Surgical Technique

Colin H Beckwitt  1 , Emerald D Robertson  1 , Ja Hea Gu  1 , Maria M Munsch  1 , Mark E Baratz  1 , Robert A Kaufmann  1
Affiliations

Elbow Uncemented Hemiarthroplasty: Surgical Technique

Colin H Beckwitt et al. J Hand Surg Glob Online. .

Abstract

Management of elbow arthritis in younger and higher demand patients is challenging and may benefit from a distal humerus hemiarthroplasty that employs a noncemented method of implant fixation and stabilizes the elbow through ligament reconstruction. By not replacing both articulating surfaces, hardware longevity may be improved. We describe a novel system that may be indicated for the treatment of posttraumatic or primary osteoarthritis of the distal humerus. The step-by-step technique for surgical implantation of this uncemented distal humerus hemiarthroplasty is described and illustrated.

Keywords: Elbow arthritis; Elbow hemiarthroplasty; Elbow stability; Ligament reconstruction; Surgical technique.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Identification of the centerline of the IM canal and centerline of ulnohumeral rotation are the two critical steps to distal humerus hemiarthroplasty implantation. A Identification of the centerline of the IM canal and centerline of ulnohumeral rotation. B A rongeur and pilot drill bit are used to identify the canal. C, D Custom drill bits are used to identify and widen the IM canal along its axis. E The centerline of ulnohumeral rotation is identified and marked with K-wires. F The final construct prior to distal humeral resection is achieved.
Figure 2
Figure 2
A Custom distal humeral cutting block is shown. B Cutting block is placed over IM guide and oriented to the ulnohumeral centerline of rotation. C, D A sagittal saw is used to remove the anterior distal humerus flush to the cutting block and in line with the ulnohumeral centerline of rotation. E The distal humerus is again sized to an appropriate implant.
Figure 3
Figure 3
A Cutting block is used to guide distal humeral resection. B Care is taken to not remove too much medial or lateral bone proximally. C After resection, the cutting block fits well in the resection bed and in line with the IM drill bit. D Bone distal to the cutting block is removed. E The final product of the distal humeral resection is obtained.
Figure 4
Figure 4
A, B Custom linear broaches are used to carefully remove medial and lateral metaphyseal bone to accommodate the implant. C Custom IM taps are shown. D Custom IM taps are used to tap the humeral diaphysis for IM screw fixation. E IM screws are shown.
Figure 5
Figure 5
A A custom CLRD is employed for ligamentous reconstruction. B Tendon grafts are passed through the CLRD on both sides and inserted into the distal humeral prosthesis. C Holes are drilled in the medial and lateral epicondyles to pass tendon graft from central to external. D The IM screw is tightened to two-finger tightness to fully seat the distal humerus hemiarthroplasty on the distal humeral surface.
Figure 6
Figure 6
A Finalization of ligament reconstruction begins with identifying the landmarks of the lateral ulnar collateral ligament on the proximal ulna. B A custom toothed plate is used to apply force and compress the tendon graft to the bone. C The two plates and provisionally placed on the proximal ulna. D The tendon grafts are passed deep to the plates and tensioned with 80 N total pull. E For grafts with poor quality tissue, ligament reconstruction can be augmented with a #2 PDS. F Final implant and ligament reconstruction produces a stable elbow.
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