Periprosthetic joint infection represents a devastating complication after total elbow arthroplasty. Several measures can be implemented before, during, and after surgery to decrease infection rates, which exceed 5%. Debridement with antibiotics and implant retention has been reported to be successful in less than one-third of acute infections, but still plays a role. For elbows with well-fixed implants, staged retention seems to be equally successful as the more commonly performed two-stage reimplantation, both with a success rate of 70% to 80%. Permanent resection or even amputation are occasionally considered. Not uncommonly, a second-stage reimplantation requires complex reconstruction of the skeleton with allografts, and the extensor mechanism may also be deficient. Further developments are needed to improve our management of infection after elbow arthroplasty. Cite this article:
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. 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. Aims
Patients and Methods
The treatment of septic arthritis of the shoulder is challenging.
The infection frequently recurs and the clinical outcome can be
very poor. We aimed to review the outcomes following the use of
continuous negative pressure after open debridement with a large
diameter drain in patients with septic arthritis of the shoulder. A total of 68 consecutive patients with septic arthritis of the
shoulder underwent arthrotomy, irrigation and debridement. A small
diameter suction drain was placed in the glenohumeral joint and
a large diameter drain was placed in the subacromial space with
continuous negative pressure of 15 cm H2O. All patients
received a standardised protocol of antibiotics for a mean of 5.1
weeks (two to 11.1).Aims
Patients and Methods
Treatment of an infected total elbow replacement
(TER) is often successful in eradicating or suppressing the infection.
However, the extensor mechanism may be compromised by both the infection
and the surgery. The goal of this study was to assess triceps function
in patients treated for deep infection complicating a TER. Between
1976 and 2007 a total of 217 TERs in 207 patients were treated for
infection of a TER at our institution. Superficial infections and
those that underwent resection arthroplasty were excluded, leaving
93 TERs. Triceps function was assessed by examination and a questionnaire.
Outcome was measured using the Mayo Elbow Performance Score (MEPS). Triceps weakness was identified in 51 TERs (49 patients, 55%).
At a mean follow-up of five years (0.8 to 34), the extensor mechanism
was intact in 13 patients, with the remaining 38 having bone or
soft-tissue loss. The mean MEPS was 70 points (5 to 100), with a
mean functional score of 18 (0 to 25) of a possible 25 points. Infection following TER can often be eradicated; however, triceps
weakness occurs in more than half of the patients and may represent
a major functional problem. Cite this article:
We report our experience of staged revision surgery
for the treatment of infected total elbow arthroplasty (TEA). Between
1998 and 2010 a consecutive series of 33 patients (34 TEAs) underwent
a first-stage procedure with the intention to proceed to second-stage
procedure when the infection had been controlled. A single first-stage procedure
with removal of the components and cement was undertaken for 29
TEAs (85%), followed by the insertion of antibiotic-impregnated
cement beads, and five (15%) required two or more first-stage procedures.
The most common organism isolated was coagulase-negative Staphylococcus in
21 TEAs (62%). A second-stage procedure was performed for 26 TEAs (76%); seven
patients (seven TEAs, 21%) had a functional resection arthroplasty
with antibiotic beads in situ and had no further
surgery, one had a persistent discharge preventing further surgery. There were three
