A Case of Bilateral Revision Total Elbow Arthroplasty after Simulation Using Stereolithographic Models

Abstract

This report presents a case in which preoperative simulation was performed using three-dimensional computed tomography (CT) reconstruction images and stereolithographic models before bilateral reimplantation for damage accompanied by a massive bone defect associated with a total elbow arthroplasty (TEA) implant. A 64-year-old man with rheumatoid arthritis (who had undergone left TEA using a Souter-Strathclyde implant 18 years earlier) experienced implant failure and dislocation of the implant. There were large bone defects of the humerus and the ulna, which could have resulted in insufficient fixation during reimplantation. However, preoperative simulation using three-dimensional CT reconstruction images and stereolithographic models showed that sufficient fixation could be achieved. Surgery was successfully performed according to the preoperative plan. This patient had previously undergone right TEA, and this implant had been removed 14 years earlier without reimplantation. A similar preoperative simulation on the right elbow demonstrated that the procedure could be performed, despite a large bone defect of the humerus. This method made it possible to perform a detailed investigation to determine the appropriate implant size and the correct site of entry. Such simulations could be applied in the field of orthopedic surgery using material models.