RESEARCH - Reimplantation of a total elbow prosthesis following resection arthroplasty for infection

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J Bone Joint Surg Am. 2008 Mar;90(3):589-94.

Reimplantation of a total elbow prosthesis following resection

arthroplasty for infection.

Cheung EV, RA, Morrey BF.

Department of Orthopedic Surgery, Stanford University, 300 Pasteur

Drive, R155, Stanford, CA 94305, USA.

BACKGROUND: The best approach for treatment of infection after total

elbow arthroplasty is not clearly defined. The purpose of this study

was to report our experience with reimplantation of a total elbow

prosthesis following a prior resection arthroplasty to treat

infection. METHODS: Between 1976 and 2003 at our institution,

twenty-nine patients were treated with reimplantation of a total elbow

prosthesis after a prior resection arthroplasty following a deep

periprosthetic infection. Eleven of the twenty-nine patients had had

at least one procedure performed on the elbow prior to the primary

arthroplasty. The mean time interval between the resection

arthroplasty and the reimplantation was 72.5 weeks. Patients were

followed for an average of 7.4 years after the reimplantation. All

patients were assessed clinically, and their medical records were

retrospectively reviewed. RESULTS: The mean total Mayo Elbow

Performance Score (MEPS) was 35.5 points (range, 15 to 60 points)

before the reimplantation and 66.3 points (range, 20 to 100 points)

postoperatively (p < 0.001). The most common infecting organism was

Staphylococcus epidermidis, which was present in thirteen (45%) of the

twenty-nine elbows, followed by methicillin-sensitive Staphylococcus

aureus, which was present in seven (24%). The infection was not

eradicated in eight elbows (28%).

CONCLUSIONS: Reimplantation of a total elbow prosthesis after a prior

resection arthroplasty is a reasonable option for the treatment of

infection. Improvement in function can be expected in most patients.

However, the chance of the infection recurring and requiring

additional revision surgery is high.

PMID: 18310709

http://www.ncbi.nlm.nih.gov/pubmed/18310709

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