Ulnar Cortical Window for Removal of a Well-Fixed Ulnar Component in Total Elbow Arthroplasty: Surgical Technique and Case Report

Abstract

Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. When comparing with other techniques in the removal of the ulnar component, such as transverse ulnar osteotomy, and extended olecranon osteotomy, our technique did not breach the bony integrity of ulna, and it did not require wiring for rigid fixation of the bony fragment. This may be more applicable in excisional arthroplasty for the management of infected total elbow arthroplasty.