Transverse ulna osteotomy for revision total elbow arthroplasty: Surgical technique and outcomes

Revision total elbow arthroplasty (TEA) presents a significant surgical challenge. Component removal, especially of a wellfixed ulnar stem can be particularly difficult and require osteotomy for stem or cement removal. Prior literature has examined the use of a longitudinal osteotomy, which poses risks for healing and distal perforation. In this case series, we present a technique and results of using a transverse osteotomy of the ulna for aid in component removal. A retrospective review of all patients undergoing revision TEA at our institution was performed. Patients who underwent a transverse osteotomy were identified. Intraoperative and postoperative data were queried, including basic demographic information, type of fixation used for osteotomy closure, and rates of healing and complications. Overall, 14 elbows in 14 patients representing 33% of all revisions done over an 18-year period underwent a transverse osteotomy. Twelve of these were eligible for inclusion with adequate radiographic follow-up to evaluate for healing. The majority of osetotomies (10 of 12) healed without complications, regardless of fixation technique. There was no associated with distal ulna perforation. Deep infection occurred in 3 patients. Revision TEA still remains a challenge to surgeons. A transverse ulnar osteotomy is a safe and effective way to aid in removal of a well-fixed component.