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Custom ulna megaprosthesis use in revision total elbow replacement
Parag Raval1, Hassan Raja1, Oubida Asaad1
1Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom.
Journal of Shoulder and Elbow Surgery
|December 29, 2025
Summary
Custom ulna megaprosthesis (CUMP) offers a reliable solution for challenging revision total elbow arthroplasty (rTEA) cases with bone loss. This study shows good early-to-mid-term outcomes and satisfactory patient-reported results for CUMP in non-tumor indications.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Revision total elbow arthroplasty (rTEA) is increasing, presenting challenges due to bone loss in the proximal ulna.
- Limited treatment options exist, including impaction grafting, strut allograft, and allograft prosthetic composite.
- Custom ulna megaprosthesis (CUMP) is a viable option, but evidence for its use in non-tumor revision TEA is scarce.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of custom ulna megaprosthesis (CUMP) in revision total elbow arthroplasty (rTEA) for non-tumor indications.
- To assess the safety and efficacy of CUMP in complex cases with significant proximal ulnar bone loss.
Main Methods:
- Retrospective review of patients undergoing CUMP for rTEA at a tertiary referral center.
- Data collection included demographics, indications, prior surgeries, follow-up duration, range of motion, complications, and patient-reported outcomes (Oxford Elbow Score, Pain, EQ5D, SANE).
- Radiographic assessment of bone loss (Mansat's grading) and implant stability was performed.
Main Results:
- The cohort included 15 elbows with a mean follow-up of 2 years; mean prior surgeries were 3.
- Indications included infection (8), periprosthetic fracture (4), and aseptic loosening (3).
- Good early-to-mid-term clinical outcomes were observed, with improvements in range of motion and patient-reported scores; complications were low, with two cases of recurrent deep infection.
Conclusions:
- Custom ulna megaprosthesis (CUMP) demonstrates good early to mid-term clinical and radiographic outcomes for revision total elbow arthroplasty (rTEA) in non-tumor cases.
- Complication rates are relatively low, and patient-reported outcomes are satisfactory, indicating CUMP is a reliable solution.
- Careful planning is essential for successful CUMP implementation in challenging rTEA scenarios.
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