Cement-within-cement technique cuts surgical time for revision total elbow arthroplasty

Numerous complications cited, but rates and types of complications were similar between groups.

Using a cement-within-cement technique can reduce operative time for revision total elbow arthroplasty while producing results similar to traditional revision procedures, according to a study by Mayo Clinic Researchers.

George S. Athwal, MD, FRCSC, and Bernard F. Morrey, MD, conducted the study, which included 24 patients with 27 fractured total elbow arthroplasty components treated from December 1979 to December 2003. In all cases, component fracture occurred in a stem portion unprotected by host bone and adjacent to the linkage or articular apparatus. Four surgeons performed all revision procedures and implanted a Coonrad-Morrey semiconstrained prosthesis in all but one case, which received a Coonrad implant (Zimmer), according to the study.

In 14 cases, surgeons cemented the new component into an expanded cement mantle, referred to as a cement-within-cement technique. They only used this technique in cases where preoperative radiographs showed an intact cement mantle with a preserved, non-osteolytic cement-bone interface, the authors noted.

For the remaining 12 cases, surgeons used a more traditional revision approach and removed the entire cement mantle. This approach involved cementing into a reamed, cement-free medullary cavity with or without strut allograft augmentation, according to the study.

The authors noted that operative time was significantly less for patients treated with a cement-within-cement technique. For these patients, surgery lasted an average of 167 minutes vs. 213 minutes for patients treated with the more traditional technique (P=.009), according to the study.

Preoperatively, all patients reported moderate-to-severe pain and had trouble using the affected arm for daily activities. At a mean 5.1 years follow-up, patients had an average Mayo Elbow Performance Score (MEPS) of 79 points, with the pain component averaging 32 points and the functional component averaging 21 points.

Final arc of motion averaged 108°, with flexion averaging 131° and extension averaging 23°, according to the study.

Patients treated with the cement-within-cement technique had an average MEPS of 82 points compared with an average MEPS of 78 points for patients treated with the more traditional technique. Researchers noted that 10 of the cement-within-cement patients and five traditional technique patients had a satisfactory MEPS.

Surgeons cited numerous complications, with 19 noted among 14 patients. However, rates and types of complications were similar between groups, the authors said.

Six patients experienced seven intraoperative complications, all of which were cortical perforations measuring less than 1 cm². Five patients developed transient nerve complications, one patient had ulnar nerve paresthesias, one patient had a radial nerve palsy and three patients sustained a triceps tendon avulsion. Other complications included one patient who sustained an olecranon fracture during manipulation and one patient who sustained a stable periprosthetic humeral shaft fracture, according to the study.

For more information:
Athwal GS, Morrey BF. Revision total elbow arthroplasty for prosthetic fractures. J Bone Joint Surg Am. 2006;88-A:2017-2026.