The purpose of this study was to review our experience with the treatment of 25 infections (in 25 patients) after total elbow arthroplasty and to examine indications for salvage of the prosthesis compared with those for resection arthroplasty. The patients were divided into 3 groups on the basis of treatment. Group I comprised 14 patients who were managed with multiple, extensive irrigation and débridement procedures with retention of the original components. The primary indication for retention of the prosthesis was evidence that it was well fixed as determined both radiographically and intraoperatively. Group II comprised 6 patients who had removal of the prosthesis and débridement followed by immediate or staged reimplantation. Group III comprised 5 patients who were managed with resection arthroplasty. The infection was successfully eradicated in 7 of the 14 elbows that had salvage of the prosthesis with irrigation and débridement. The results were strongly dependent on the causative organism; attempts at débridement failed in the 4 elbows that were infected with Staphylococcus epidermidis compared with 3 of the 10 that were infected with another organism. 4 of the 6 patients in Group II had successful reimplantation of a prosthesis; in 3, the infection had been caused by an organism other than Staphylococcus epidermidis. Only one of the 3 patients who had a Staphylococcus epidermidis infection had a successful reimplantation. None of the 5 patients who had a resection arthroplasty had signs of infection at the latest follow-up examination. We concluded that salvage of the prosthesis with extensive irrigation and débridement in the presence of an infection about the elbow can be reasonably successful if the infecting organism is not Staphylococcus epidermidis and if the components are well fixed. When removal of the components is warranted, staged reimplantation can also be highly successful when the infecting organism is not Staphylococcus epidermidis. However, the repeated operations necessary to retain a prosthesis and the high rates of complications seen with this approach — and the relatively good rates of satisfaction obtained with resection arthroplasty — suggest that resection arthroplasty remains the procedure of choice in medically frail patients or in patients for whom function of the elbow is less of a concern.
Copyright remains with the authors and publisher.
The purpose of this study was to review our experience with the treatment of 25 infections (in 25 patients) after total elbow arthroplasty and to examine indications for salvage of the prosthesis compared with those for resection arthroplasty. The patients were divided into 3 groups on the basis of treatment. Group I comprised 14 patients who were managed with multiple, extensive irrigation and débridement procedures with retention of the original components. The primary indication for retention of the prosthesis was evidence that it was well fixed as determined both radiographically and intraoperatively. Group II comprised 6 patients who had removal of the prosthesis and débridement followed by immediate or staged reimplantation. Group III comprised 5 patients who were managed with resection arthroplasty. The infection was successfully eradicated in 7 of the 14 elbows that had salvage of the prosthesis with irrigation and débridement. The results were strongly dependent on the causative organism; attempts at débridement failed in the 4 elbows that were infected with Staphylococcus epidermidis compared with 3 of the 10 that were infected with another organism. 4 of the 6 patients in Group II had successful reimplantation of a prosthesis; in 3, the infection had been caused by an organism other than Staphylococcus epidermidis. Only one of the 3 patients who had a Staphylococcus epidermidis infection had a successful reimplantation. None of the 5 patients who had a resection arthroplasty had signs of infection at the latest follow-up examination. We concluded that salvage of the prosthesis with extensive irrigation and débridement in the presence of an infection about the elbow can be reasonably successful if the infecting organism is not Staphylococcus epidermidis and if the components are well fixed. When removal of the components is warranted, staged reimplantation can also be highly successful when the infecting organism is not Staphylococcus epidermidis. However, the repeated operations necessary to retain a prosthesis and the high rates of complications seen with this approach — and the relatively good rates of satisfaction obtained with resection arthroplasty — suggest that resection arthroplasty remains the procedure of choice in medically frail patients or in patients for whom function of the elbow is less of a concern.
Copyright remains with the authors and publisher.