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Infection after total elbow arthroplasty

K Yamaguchi1, R A Adams, B F Morrey

  • 1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

The Journal of Bone and Joint Surgery. American Volume
|May 1, 1998
PubMed
Summary

Treating elbow joint infections after total elbow arthroplasty depends on the bacteria. Salvage procedures are effective for non-Staphylococcus epidermidis infections, while resection arthroplasty is a reliable option for frail patients.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease Management

Background:

  • Post-arthroplasty infections pose significant challenges in total elbow replacement.
  • Treatment strategies for periprosthetic joint infections (PJIs) include component retention, debridement and reimplantation, or resection arthroplasty.

Purpose of the Study:

  • To review treatment outcomes for 25 patients with infections after total elbow arthroplasty.
  • To compare indications for prosthesis salvage versus resection arthroplasty in managing these infections.

Main Methods:

  • Patients were categorized into three groups: irrigation and debridement with component retention (Group I), prosthesis removal with reimplantation (Group II), and resection arthroplasty (Group III).
  • Treatment success was evaluated based on infection eradication and functional outcomes.

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  • Causative organisms, particularly Staphylococcus epidermidis, were analyzed for their impact on treatment success.

    • Main Results:

    • Infection eradication was achieved in 7 of 14 patients (50%) undergoing irrigation and debridement with component retention.
    • Salvage success was significantly lower for Staphylococcus epidermidis infections (0/4) compared to other organisms (7/10).
    • Reimplantation (Group II) was successful in 4 of 6 patients, with better outcomes when the infection was not caused by Staphylococcus epidermidis (3/4 success).
    • Resection arthroplasty (Group III) resulted in no signs of infection in all 5 patients at follow-up.

    Conclusions:

    • Prosthesis salvage with irrigation and debridement is a viable option for elbow joint infections if components are well-fixed and the organism is not Staphylococcus epidermidis.
    • Staged reimplantation can be successful for non-Staphylococcus epidermidis infections.
    • Resection arthroplasty is a reliable procedure, especially for medically frail patients or when elbow function is a lesser concern, due to its lower complication rates compared to repeated salvage attempts.