Treatment of periprosthetic joint infection of the elbow: 15-year experience at a single institution

Benjamin Zmistowski, Alborz Pourjafari, Eric M. Padegimas, Mihir Sheth, Ryan M. Cox, Matthew L. Ramsey, John G. Horneff, Surena Namdari

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: Total elbow arthroplasty (TEA) can be complicated by periprosthetic joint infection (PJI) with potentially catastrophic failure. The purpose of this study was to describe the results of elbow PJI treatment at a tertiary-care referral center. Methods: An institutional TEA database was queried for infection and reoperation after TEA. Patients who underwent irrigation and débridement (I&D) with component retention were compared with those who underwent component explantation, antibiotic spacer placement, and reimplantation of a revision TEA. Results: A total of 26 patients (10 men; mean age, 64.3 years) were treated for PJI of TEA. There were 3 polymicrobial infections (11.5%) and 13 Staphylococcus aureus infections (50%) (4 methicillin resistant); 6 patients (23.1%) had negative culture results. Ten patients (38.5%) underwent I&D and component retention, with 5 of those patients (5 of 10, 50%) having recurrent infection at an average of 3.1 years (range, 0.25-7.8 years) after I&D. Of 16 patients who underwent antibiotic spacer placement, 12 (75%) underwent 2-stage reimplantation of a TEA. Among those with reimplantation, 4 of 12 (33.3%) required reoperation. In 3 of 12 (25.0%), reoperation was required for infection, whereas 1 of 12 (8.3%) required surgery for mechanical complications. Conclusion: Two-stage revision results in a decreased rate of recurrent PJI. Certain patients (those with poor health or well-fixed components) may be more suitable for I&D and component retention, with a demonstrated 50% success rate over a period of 3 years. Longer-term follow-up may result in higher reinfection rates in both groups.

Original languageEnglish
Pages (from-to)1636-1641
Number of pages6
JournalJournal of Shoulder and Elbow Surgery
Volume27
Issue number9
DOIs
StatePublished - Sep 2018

Keywords

  • Elbow arthroplasty
  • Level III
  • Retrospective Cohort Design
  • Treatment Study
  • complications
  • elbow periprosthetic joint infection
  • infection
  • reoperations
  • total elbow

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