Abstract
Although total elbow arthroplasty is undertaken in far smaller numbers than total hip and knee arthroplasty a recent review of the world literature indicated that aseptic loosening radiologically occurred in 17.2% whilst clinical loosening was present in 6.4%. In addition, infections were noted in 8.1%
With both aseptic and septic loosening bone loss can be a major problem and must be addressed if revision surgery is contemplated Options for treating bone loss include:
-
Revision with standard implant
-
Revision with customised implant
-
Revision with impaction bone grafting and standard or customised implant
-
Revision with allograft and standard or customised implant
When considering revision surgery it is essential to ascertain whether or not implant loosening is aseptic or septic. To this end screening blood tests including white blood count, ESR and CRP should be performed. A bone scan may also be helpful. In addition, it is my practice to perform an aspiration biopsy prior to revision surgery. A sample of fluid from the elbow joint is looked at microscopically and cultured for organism sensitivity.
If infection is present surgery is undertaken as a two-stage procedure. The first stage involves removal of the implant and bone cement together with the insertion of antibiotic beads specially prepared with added antibiotics appropriate to the sensitivity of the infectiong organism.
If infection is not present then a one-stage revision is performed.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
