Elbow allograft for reconstruction of the elbow with massive bone loss. Long term results

Abstract

Transplantation of total elbow allografts has been used as a salvage procedure in an attempt to provide patients with functional, painless range of motion of the elbow. This procedure is appropriate for patients with massive bone loss after trauma, tumor resection, or revision elbow arthroplasty. During the past 20 years, 23 patients have undergone elbow allograft reconstruction with variable results and a high complication rate. Ten of 14 patients with elbow allografts observed for an average of 7.5 years report satisfactory results. Allograft removal was required in six patients: for infection (two), instability (three), and nonunion and resorption (one). Three patients with instability have since undergone successful total elbow arthroplasty. Two patients have been observed less than 1 year and another patient died during the study period. Complications occurred in 16 of 23 patients. This operation is not recommended for routine use and 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 allograft reestablishes bone mass to permit an arthrodesis or reconstructive arthroplasty.