Reconstructive surgery following total elbow endoprosthesis.

Elbow arthroplasty should only be undertaken by surgeons who have considerable experience in total arthroplasty and special training in upper-extremity surgery. The failed total prosthesis presents a formidable challenge. The recognition of this fact fortunately has had an impact on prosthetic design, so that less bone stock is removed at surgery. In addition, second- and third-generation arthroplasties are becoming available that biomechanically are more suitable and that may be expected to be somewhat more durable than those of the first generation. Early and decisive action is recommended in the case of the loose elbow joint prosthesis before the cement mantle causes further abrasive wear to the cortex, which eventually may be broken through, rendering revision much more difficult. If there is any doubt about the adequacy of the bone stock to receive a further prosthesis after removal of the failed joint, a nonprosthetic salvage procedure, or, alternatively, revision as a two-stage procedure is recommended. In the case of the failed surface implant, nonprosthetic interposition arthroplasty will usually give a satisfactory result.