A 33-year-old male presents with complaints of left elbow pain

A 33-year-old male presents with complaints of left elbow pain. He sustained a terrible triad injury 10 years prior following a motorcycle accident. He underwent multiple surgeries on the elbow and was doing relatively well until the past 2 years. He reports that recently his elbow has become increasingly painful and he is having trouble working out, specifically while doing pushups and dips.

Past surgical history:

2011: Left ORIF coronoid, lateral ulnar collateral ligament repair, and radial head replacement at outside institution. Also underwent ORIF of multiple ribs, prior VATS, splenectomy, ORIF left wrist

2017: Left ulnar nerve transposition at outside institution

2019: Revision left radial head replacement (head exchange only) for crepitus - metallosis was documented at that time (screw that fixed the radial head to the stem was found to be loose) at outside institution

Focused examination of the left elbow reveals well-healed medial and lateral skin incisions. Active ROM flexion-extension arc of the elbow is 15°-135° with near-complete pronation-supination. No evidence of instability. Notable lateral-sided clicking and crepitus with elbow range of motion. Diminished sensation in small finger. Some lateral muscle wasting compared to the contralateral side is appreciated. In-office fluoroscopic imaging was utilized to evaluate for tracking and gapping of the joint which revealed presumed shifting of the radial head on the stem, posterior subluxation of the joint, and minor gapping with varus stress.

If you choose Operative management, what treatment would you perform?

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