Resection arthroplasty for periprosthetic infection after total elbow arthroplasty

Periprosthetic infection after total elbow arthroplasty (TEA) is a serious complication that has no clearly defined treatment. The purpose of this study was to report the outcomes of resection arthroplasty for treatment of infection after TEA and the factors influencing the result.

Ten elbows (9 patients) underwent resection arthroplasty for treatment of infection after TEA. The mean follow-up duration was 52.4 (range, 24-113) months. According to remnant distal humerus bone stock, we divided the elbows into 3 groups: lateral column, medial column, and both columns.

The average time to resolution of symptoms of clinical infection and normalization of serologic marker levels was 6.8 (range, 5-12) and 68.5 (range, 20-148) days after resection. The mean Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder, and Hand score changed from 50.0 (range, 40-60) and 46.5 (range, 29-67) preoperatively to 73.5 (range, 55-85) and 53.0 (range, 33-65) at the last follow-up (P < .001 and P < .001, respectively). Although it was insignificant, the both-columns group showed better functional outcomes (Mayo Elbow Performance Score, 80.0; Disabilities of the Arm, Shoulder, and Hand score, 43.7) than the lateral (74.0, 54.6) or medial (62.5, 63.0) column group. The mean satisfaction score was 70.0 (range, 50-80) at the final follow-up. Only 1 case required additional operations to treat recurrent infection. There were no refractory infections, fractures, or permanent nerve lesions.

Resection arthroplasty can be an acceptable salvage treatment for infection after TEA for low-demand patients. To achieve success, both columns of the distal humerus must be preserved at implant removal.