This Mayo Clinic series reviews 25 consecutive infections after total elbow arthroplasty. Patients were grouped by treatment: irrigation and débridement with retention, removal with reimplantation, or resection arthroplasty. The study defines when the prosthesis can be salvaged versus when resection is needed.
When you face an infected total elbow, three variables decide your move: the organism, component fixation, and symptom duration. If the components are well fixed, symptoms are under 30 days, and the organism is not S. epidermidis, débridement with retention is reasonable. Disarticulate the components, remove the pin and bushings, exchange antibiotic cement beads, and plan multiple débridements.
S. epidermidis is the trap. Its biofilm forms within 24 hours and coats even antibiotic cement, so both retention and reimplantation fail regardless of how fast you treat. For these patients, favor resection.
Remember that salvage is not free: 6 of 14 retention cases had complications, including 3 irreversible nerve injuries. Resection eradicated infection in every patient and satisfied most, so it remains the fallback for the medically frail, for loose components, or when function matters less than clearing the infection.
This Mayo Clinic series reviews 25 consecutive infections after total elbow arthroplasty. Patients were grouped by treatment: irrigation and débridement with retention, removal with reimplantation, or resection arthroplasty. The study defines when the prosthesis can be salvaged versus when resection is needed.
When you face an infected total elbow, three variables decide your move: the organism, component fixation, and symptom duration. If the components are well fixed, symptoms are under 30 days, and the organism is not S. epidermidis, débridement with retention is reasonable. Disarticulate the components, remove the pin and bushings, exchange antibiotic cement beads, and plan multiple débridements.
S. epidermidis is the trap. Its biofilm forms within 24 hours and coats even antibiotic cement, so both retention and reimplantation fail regardless of how fast you treat. For these patients, favor resection.
Remember that salvage is not free: 6 of 14 retention cases had complications, including 3 irreversible nerve injuries. Resection eradicated infection in every patient and satisfied most, so it remains the fallback for the medically frail, for loose components, or when function matters less than clearing the infection.