Bilateral elbow joint osteonecrosis reconstructed by custom distal humerus hemiarthroplasty and megaprosthesis with tendon and nerve transfers - A case report.

We present the case of a patient with bilateral distal humerus osteonecrosis following chemoradiation for lymphoma. Treatment consisted of a right total elbow arthroplasty with a distal humerus megaprosthesis and a left custom-made distal humerus hemiarthroplasty, replacing exclusively the humeral articular cartilage while preserving the native medial and lateral humeral columns. By using a custom implant of this design, we were able to avoid the weight-bearing and lifting restrictions to which patients have to adhere following a typical total elbow arthroplasty. Thus, we were able to preserve weight-bearing capacity in the dominant arm of the patient, which she required to act as a caregiver to a disabled family member. The case was complicated by a concurrent high radial nerve palsy which was treated by nerve decompression and transfers of tendons and nerves. Ultimately, bilateral upper extremity function was good with negligible pain at 2 years of follow-up. In conclusion, this case demonstrates the value of a combined orthoplastic approach and custom implants in successfully reconstructing complex upper extremity defects such as bilateral elbow joint osteonecrosis.