Thomas L. Mehlhoff, MD
I have a useful tip for readers who perform total elbow arthroplasty and revision arthroplasty.
Unfortunately, total elbow arthroplasty is sometimes complicated by a need for revision due to mechanical loosening, bushing wear, or late infection. Replacing the bushings for the Morrey-Coonrad total elbow implant for retained implants can be challenging during surgery. There is no specific instrumentation to assist the replacement of new bushings for the humeral and ulnar components.
However, two commonly found tools in the operating room can make bushing replacement simple and efficient: the customary sponge clamp, and a cylindrical bone punch.
To replace the ulnar component bushing, the bone tap punch is guided through the first portion of the sponge clamp. The bushing is then loaded onto the bone tap and guided up to the ulnar component. The bone punch is then passed through the ulnar component and through the second limb of the sponge clamp.
The punch cylinder will secure the bushing, so that it cannot be dropped or fall from the table. Squeezing the sponge clamp together will provide uniform compression on the bushing, without deforming the surfaces, and will smoothly insert the bushing into the ulnar component.
In a similar manner, the bushings for the humeral component can be inserted easily, even with tight spaces for the humeral component.
I hope membership finds this to be a useful tip, if and whenever revision arthroplasty of the Morrey-Coonrad total elbow might be required.