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Published on: December 3, 2017
Two-stage reimplantation for deep infection after total elbow arthroplasty
Natalia Martinez-Catalan1,2, Ngoc Tram V Nguyen1, Mark E Morrey1
1Department of Orthopedic Surgery, Mayo Clinic, USA.
Background:
Persistent infection rate after 2-stage reimplantation complicating elbow arthroplasty has been reported to be as high as 25%. The purposes of this retrospective study were to determine the infection eradication rates, complications and outcomes in a cohort of patients treated with two-stage reimplantation for deep periprosthetic joint infection (PJI) following total elbow arthroplasty (TEA) and to determine possible associated risk factors for treatment failure.
Methods:
Between 2000 and 2017, 52 elbows underwent a two-stage reimplantation for PJI after TEA. There were 22 males and 30 females with a mean age of 61 (range, 25-82) years. The most common bacterium was Staphylococcus epidermidis (28 elbows). Mayo Elbow Performance Scores were calculated at the latest follow-up. Mean follow-up time was 6 years (range, 2-14 years).
Results:
PJI was eradicated in 36 elbows (69%). The remaining 16 elbows were considered treatment failures secondary to recurrent infection. The risk of persistent infection was 3.3 times higher in elbows with retained cement (p 0.04), and 3.5 times higher when the infecting organism was Staphylococcus epidermidis (p 0.06).
Conclusion:
Two-stage reimplantation for PJI after TEA was successful in eradicating deep infection in 69% of cases. The eradication of PJI after TEA still needs to be improved substantially.
Insights
Two-stage reimplantation for deep periprosthetic joint infection (PJI) after total elbow arthroplasty (TEA) eradicated infection in 69% of cases. Persistent infection risk increased with retained cement and Staphylococcus epidermidis.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Deep periprosthetic joint infection (PJI) following total elbow arthroplasty (TEA) presents a significant challenge, with reported persistent infection rates up to 25% after two-stage reimplantation.
- Effective management strategies for PJI after TEA are crucial for improving patient outcomes and reducing long-term complications.
Purpose of the Study:
- To evaluate the efficacy of two-stage reimplantation in eradicating deep PJI after TEA.
- To identify complications and assess outcomes in patients undergoing this procedure.
- To determine risk factors associated with treatment failure in PJI after TEA.
Main Methods:
- A retrospective study analyzed 52 patients (22 males, 30 females; mean age 61 years) who underwent two-stage reimplantation for PJI after TEA between 2000 and 2017.
- The most common causative organism identified was *Staphylococcus epidermidis* (28 elbows).
- Mayo Elbow Performance Scores were assessed at a mean follow-up of 6 years.
Main Results:
- Infection eradication was achieved in 36 elbows (69%), while 16 elbows (31%) experienced treatment failure due to recurrent infection.
- A 3.3-fold higher risk of persistent infection was observed in elbows with retained cement (p=0.04).
- A 3.5-fold higher risk of persistent infection was associated with *Staphylococcus epidermidis* (p=0.06).
Conclusions:
- Two-stage reimplantation successfully eradicated deep PJI in 69% of cases following TEA.
- Current eradication rates for PJI after TEA require substantial improvement, necessitating further research into optimizing treatment protocols.
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