Clinical and radiographic outcomes of allograft-prosthesis composite reconstruction in revision total elbow arthroplasty with significant bone loss: a systematic review.

Total elbow arthroplasty (TEA) is increasingly performed for complex elbow pathology, yet revision procedures remain challenging due to high complication rates and limited bone stalk. While TEA may produce satisfactory functional outcomes for select patients, it is often burdened by high complication rates, necessitating revision TEA, often with extensive bone loss. Among available reconstructive strategies, allograft-prosthesis composite (APC) reconstruction has emerged as a possible technique; however, reported outcomes remain heterogeneous. This systematic review aims to characterize the use and outcomes of APC reconstruction in revision TEA for patients with significant bone loss. We searched the PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify clinical studies of revision TEA performed with an APC published between inception of each database and 2023. Outcomes of interest were patient-reported outcome measures (PROMs), range of motion (ROM), radiographic outcomes, and complications. We included five studies that reported on 85 elbows with APC TEA revisions for extensive bone loss. PROMs and ROM were reported for 70 elbows, yielding a mean postoperative Mayo Elbow Performance Score of 64 points and an active elbow arc of 24°-120°. The complication rate across 85 elbows was 38.8% (33 elbows). The graft-host junction non-union rates of humeral and ulnar allografts were 40% (20 elbows) and 16% (5 elbows), respectively. APC provides a salvage option in revision TEA with severe bone loss but is associated with high complication and non-union rates.