# Revision of total elbow arthroplasty due to humeral loosening with large bone defect using humeral allograft-prosthesis composite: A case report

## TL;DR

A successful revision surgery for a patient with a loose elbow implant and bone loss used a bone graft and implant composite, resulting in good recovery.

## Contribution

Demonstrates successful use of a humeral allograft-prosthesis composite for elbow revision in a rheumatoid arthritis patient with significant bone loss.

## Key findings

- Use of allograft-prosthesis composite achieved stable integration and prevented non-union.
- Patient showed pain-free motion and improved function without complications.
- Humeral allograft is a viable option for managing elbow implant loosening with bone loss.

## Abstract

Revision of total elbow arthroplasty is a challenging procedure, especially when associated with humeral bone deficiency. The purpose of this case report is to highlight the successful management of humeral-sided loosening due to bone defects, using an allograft-prosthesis composite with a humeral bone allograft.

A 70-year-old female patient under medication for rheumatoid arthritis underwent revision of left total elbow arthroplasty due to major bone defect and loosening on the humeral side. The allograft-prosthesis composite method was used to address the bone defect and loosening of the humeral side by using humeral allograft as well as plating the host humeral bone.

There were no post-operative complications. The radiographic assessment at her latest follow-up was unremarkable, along with a significant improvement on the functional scores and range of motion.

The use of a humeral allograft is a valuable option for the management of loosened total elbow arthroplasty with significant bone loss. However, more studies need to be conducted to determine the long-term outcomes of revision surgery of total elbow arthroplasty with humeral bone loss.

•Revision of total elbow arthroplasty in RA patients with humeral-sided loosening and severe bone defect remains a major surgical challenge.•Humeral loosening in TEAs is not as common as the ulnar-sided loosening.•A humeral allograft–prosthesis composite (APC) was successfully used to reconstruct the distal humerus.•Compression plate fixation at the host–allograft junction provided stable integration and prevented non-union.•The technique achieved pain-free range of motion and excellent short-term functional outcome without complications.

Revision of total elbow arthroplasty in RA patients with humeral-sided loosening and severe bone defect remains a major surgical challenge.

Humeral loosening in TEAs is not as common as the ulnar-sided loosening.

A humeral allograft–prosthesis composite (APC) was successfully used to reconstruct the distal humerus.

Compression plate fixation at the host–allograft junction provided stable integration and prevented non-union.

The technique achieved pain-free range of motion and excellent short-term functional outcome without complications.