Management of the infected total elbow arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials

Background:

• Periprosthetic joint infection (PJI) is a significant complication after total elbow arthroplasty, with infection rates exceeding 5%.
• Managing PJI after elbow arthroplasty presents unique challenges, often leading to complex surgical interventions and potentially poor outcomes.
• Existing treatment options have variable success rates, highlighting the need for improved management strategies.

Purpose of the Study:

• To review current strategies for preventing and managing periprosthetic joint infection after total elbow arthroplasty.
• To evaluate the efficacy of different surgical approaches, including debridement with antibiotic retention and staged reimplantation.
• To identify areas for future research and development in the management of elbow PJI.

Main Methods:

• Review of current literature on periprosthetic joint infection in total elbow arthroplasty.
• Analysis of treatment outcomes for debridement with antibiotic retention, staged reimplantation, and other surgical options.
• Discussion of challenges related to complex reconstructions and extensor mechanism deficiencies.

Main Results:

• Debridement with antibiotic retention shows limited success in acute infections (less than one-third).
• Staged retention and two-stage reimplantation demonstrate comparable success rates (70-80%) for elbows with well-fixed implants.
• Complex reconstructions with allografts and extensor mechanism deficits are common challenges in second-stage reimplantation.

Conclusions:

• Effective management of periprosthetic joint infection after total elbow arthroplasty requires a multi-faceted approach.
• While some surgical options offer moderate success, significant challenges remain, particularly in complex cases.
• Further advancements in treatment protocols and surgical techniques are crucial to improve outcomes for patients with elbow PJI.