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Intramedullary Fibular and Impaction Allografting in Revision Total Elbow Arthroplasty With Endosteal Deficiency

Papadonikolakis, Anastasios MD; McKenna, Mark MD; Warme, Winston J. MD; Matsen, Frederick A. MD

Techniques in Hand & Upper Extremity Surgery: March 2012 - Volume 16 - Issue 1 - p 5–11
doi: 10.1097/BTH.0b013e318225475d

One of the many reasons for failed revision elbow replacement is loss of the normally irregular shape of the endosteal surface leading to reduced ability to provide rotational control of the humeral or ulnar component within the intramedullary canal. The endosteal bone loss of the distal humerus or proximal ulna compromises the rotational stability of the stem in the intramedullary canal. In these cases, impaction cancellous allografting techniques, similar to the ones used in revision total hip arthroplasties, are commonly used to address the osseous deficiency, but these methods are not optimal for providing rotational control of the prosthetic stem. We describe a technique of restoring the irregular shape of the endosteal bone using intramedullary fibular allografting to enhance the rotational control of the prosthetic stem within the intramedullary bone canal.

Department of Orthopedics, University of Washington, Seattle, WA

No funding related to this study was received by the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI).

Conflicts of Interest: The authors report no conflicts of interest.Address correspondence and reprint requests to Frederick A. Matsen, III, MD, Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 NE Pacific St Seattle, WA 98195. e-mail:

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