Cue Ball Arthroplasty With Humeroradial Total Elbow Arthroplasty (TEA) Revision: An Approach to Managing Infection and Severe Ulnar Bone Loss in TEA

Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.

Palliative Orthopaedic Surgery for Skeletal Metastases

Advances in oncological therapies have resulted in improved survival in patients with skeletal metastases. The resultant effect is that the skeletal metastases result in an increased incidence of pathological fracture and bone pain. This article focuses on the options available to the orthopaedic surgeon in the treatment of patients with skeletal metastases. It covers the controversial area of prophylactic fixation and the roles of conventional internal fixation, cement, arthroplasty and endoprosthetic replacement. The role of radiotherapy in the management of patients with surgically treated skeletal metastases is highlighted. Treatment for these patients is always individualised and should always be subject to a multidisciplinary approach. Despite the prognosis, satisfying results can be obtained that achieve the aims of palliative surgery, namely pain relief and maintenance of or improvement in function.