Custom triflange outrigger ulnar component in revision total elbow arthroplasty

Hypothesis: This study describes the rationale for, and tests the hypothesis that, a custom outrigger triflange ulnar component for revision total elbow arthroplasty would decrease the contact stresses at the bushings and overcome excessive bushing wear in active patients who have bone and ligamentous deficiency. Materials and methods: Five consecutive revisions for failed Coonrad-Morrey total elbow arthroplasties were performed with the custom outrigger triflange ulnar component for patients with accelerated bushing wear, ulnar component loosening, and deficient humeral condyles. The mean age at the time of surgery was 48 years (range, 32-64 years). Follow-up averaged 81 months (range, 65-124 months). The average number of previous operations was 2.4 (range, 2-3). Results: The Mayo Elbow Performance Score improved from 40 (range, 15-65) preoperatively to 91 (range, 80-100) at the latest follow-up. There were two excellent and three good results. There was no radiographic or clinical evidence of bushing wear at 6.8 years of follow-up (range, 5.5-10.3 years). One patient required further revision of the humeral component due to mechanical loosening, which had not been revised at the time of the index surgery. Discussion: A custom outrigger triflange ulnar component is an effective alternative for revising loose Coonrad-Morrey ulnar components in active patients with absent humeral epicondyles and accelerated bushing wear. Conclusion: It may be an alternative to revision with standard components until improved surgical designs addressing this problem become commercially available. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.