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Diagnosis and Management of Periprosthetic Elbow Infection

Jeremy S Somerson1, Mark E Morrey2, Joaquin Sanchez-Sotelo2

  • 1Department of Orthopaedics, University of Texas Health Science Center at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229.

The Journal of Bone and Joint Surgery. American Volume
|December 4, 2015
PubMed

Insights

Diagnosing periprosthetic elbow infections is challenging, as standard tests lack proven utility. Future diagnostic tools and surgical options offer hope for improved management of these rare infections.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Periprosthetic elbow infections are uncommon and rarely present with systemic symptoms like fever.
  • The diagnostic accuracy of blood tests and joint aspiration for elbow periprosthetic joint infections (EPJIs) remains unproven, unlike for hip and knee counterparts.
  • Intraoperative histological analysis demonstrates high specificity but low sensitivity for diagnosing EPJIs.

Purpose of the Study:

  • To review the diagnostic challenges and current management strategies for periprosthetic elbow infections.
  • To highlight the limitations of existing diagnostic methods for EPJIs.
  • To explore emerging diagnostic technologies and surgical interventions for EPJIs.

Main Methods:

  • Literature review of diagnostic modalities for periprosthetic elbow infections.
  • Analysis of the diagnostic performance of intraoperative histological examination.
  • Evaluation of current and emerging surgical treatment options for EPJIs.

Main Results:

  • Systemic symptoms are rare in periprosthetic elbow infections.
  • Blood tests and joint aspiration have not been validated for diagnosing EPJIs.
  • Intraoperative histology shows 93.1% specificity and 51.3% sensitivity.
  • Novel diagnostic approaches like implant sonication and molecular analysis show promise.
  • Surgical options include debridement, two-stage revision, and resection arthroplasty.

Conclusions:

  • Accurate diagnosis of periprosthetic elbow infections remains a significant clinical challenge.
  • Emerging diagnostic tools are expected to improve diagnostic certainty in the future.
  • A range of surgical strategies exist for managing these complex infections.

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