title: Characteristics and outcome of 27 elbow periprosthetic joint infections: results from a 14-year cohort study of 358 elbow prostheses.
abstract: Elbow arthroplasty is increasingly performed in patients with rheumatic and post-traumatic arthritis. Data on elbow periprosthetic joint infection (PJI) are limited. We investigated the characteristics and outcome of elbow PJI in a 14-year cohort of total elbow arthroplasties in a single centre. Elbow prosthesis, which were implanted between 1994 and 2007 at Schulthess Clinic in Zurich, were retrospectively screened for infection. PJI was defined as periprosthetic purulence, the presence of sinus tract or microbial growth. A Kaplan-Meier survival method and Cox proportional hazard analysis were performed. Of 358 elbow prostheses, PJI was identified in 27 (7.5%). The median patient age (range) was 61 (39-82) years; 63% were females. Seventeen patients (63%) had a rheumatic disorder and ten (37%) had osteoarthritis. Debridement and implant retention was performed in 78%, followed by exchange or removal of the prosthesis (15%) or no surgery (7%).The relapse-free survival (95% CI) was 79% (63-95%) after 1 year and 65% (45-85%) after 2 years. The outcome after 2 years was significantly better when patients were treated according to the algorithm compared to patients who were not (100% vs. 33%, p <0.05). In 21 patients treated with debridement and retention, the cure rate was also higher when the algorithm was followed (100% vs. 11%, p <0.05). The findings of the present study suggest that the treatment algorithm developed for hip and knee PJI can be applied to elbow PJI. With proper patient selection and antimicrobial therapy, debridement and retention of the elbow prosthesis is associated with good treatment outcome.
authors.affiliation: Infectious Diseases Service, Cantonal Hospital Zug, Baar, Switzerland.
authors.forename: Y
authors.initials: Y
authors.lastname: Achermann
authors.forename: M
authors.initials: M
authors.lastname: Vogt
authors.forename: C
authors.initials: C
authors.lastname: Spormann
authors.forename: C
authors.initials: C
authors.lastname: Kolling
authors.forename: C
authors.initials: C
authors.lastname: Remschmidt
authors.forename: J
authors.initials: J
authors.lastname: Wüst
authors.forename: B
authors.initials: B
authors.lastname: Simmen
authors.forename: A
authors.initials: A
authors.lastname: Trampuz
mesh_terms: D000193:Actinomycetales Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D058569:Elbow Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D012008:Recurrence; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013292:Streptococcus agalactiae; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents