Infection in total elbow arthroplasty with stable components outcomes of a staged surgical protocol with retention of the components

Philipp N Streubel, J. P. Simone, B. F. Morrey, J. Sanchez-Sotelo, M. E. Morrey

Research output: Contribution to journalArticle

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Abstract

Aims We describe the use of a protocol of irrigation and debridement (I&D) with retention of the implant for the treatment of periprosthetic infection of a total elbow arthroplasty (TEA). This may be an attractive alternative to staged re-implantation. Patients and Methods Between 1990 and 2010, 23 consecutive patients were treated in this way. Three were lost to follow-up leaving 20 patients (21 TEAs) in the study. There were six men and 14 women. Their mean age was 58 years (23 to 76). The protocol involved: component unlinking, irrigation and debridement (I&D), and the introduction of antibiotic laden cement beads; organism-specific intravenous antibiotics; repeat I&D and re-linkage of the implant if appropriate; long-term oral antibiotic therapy. Results The mean follow-up was 7.1 years (2 to 16). The infecting micro-organisms were Staphylococcus aureus in nine, coagulase-negative Staphylococcus in 13, Corynebacterium in three and other in six cases. Re-operations included three repeat staged I&Ds, two repeat superficial I&Ds and one fasciocutaneous forearm flap. One patient required removal of the implant due to persistent infection. All except three patients rated their pain as absent or mild. Outcome was rated as good or excellent in 15 patients (mean Mayo Elbow Performance Score 78 points, (5 to 100) with a mean flexion-extension arc of 103° (40° to 150°)). Conclusion A staged protocol can be successful in retaining stable components of an infected TEA. Function of the elbow may compare unfavourably to that after an uncomplicated TEA.

Original languageEnglish (US)
Pages (from-to)976-983
Number of pages8
JournalBone and Joint Journal
Volume98B
Issue number7
DOIs
StatePublished - Jan 1 2016

Fingerprint

Elbow
Arthroplasty
Infection
Debridement
Anti-Bacterial Agents
Corynebacterium
Coagulase
Lost to Follow-Up
Staphylococcus
Forearm
Staphylococcus aureus
Pain
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Infection in total elbow arthroplasty with stable components outcomes of a staged surgical protocol with retention of the components. / Streubel, Philipp N; Simone, J. P.; Morrey, B. F.; Sanchez-Sotelo, J.; Morrey, M. E.

In: Bone and Joint Journal, Vol. 98B, No. 7, 01.01.2016, p. 976-983.

Research output: Contribution to journalArticle

Streubel, Philipp N ; Simone, J. P. ; Morrey, B. F. ; Sanchez-Sotelo, J. ; Morrey, M. E. / Infection in total elbow arthroplasty with stable components outcomes of a staged surgical protocol with retention of the components. In: Bone and Joint Journal. 2016 ; Vol. 98B, No. 7. pp. 976-983.
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