Treatment strategies for periprosthetic infections after primary elbow arthroplasty.
BACKGROUND
The goal of this study was to investigate the outcome of different surgical procedures (debridement and retention vs 1- or 2-stage exchange) together with a well-defined antimicrobial regimen.


METHODS
A total of 236 consecutive patients underwent 262 primary elbow arthroplasties between January 1994 and December 2007. We observed 20 episodes of periprosthetic infections in 19 patients and placed them into 3 groups according to the occurrence of infection after index surgery. A total of 9 early infections (<3 months), 1 delayed infection (3-24 months), and 10 late infections (>24 months) were observed. The treatment among those 3 groups was compared, and the outcome was assessed with a mean follow-up of 60.2 months.


RESULTS
In the group with early infections (n = 9), 8 cases were treated by irrigation and debridement and 1 case was treated by a 2-stage exchange without recurrence of infection. The mean Mayo Elbow Performance Score improved from 48.3 points (range, 30-75 points) to 91.7 points (range, 85-100 points). The delayed infection was treated by 1-stage exchange without recurrence of infection. For late infections (n = 10), 3 cases presented recurrence of infection after debridement and irrigation, and the mean Mayo Elbow Performance Score remained nearly unchanged, from 60 points (range, 45-80 points) to 65 points (range, 50-80 points). Eradication of infection could be achieved by staged revision and in 3 cases by debridement.


CONCLUSIONS
Both debridement with retention and staged reimplantation are highly successful for appropriate indications. Staged revisions are successful even against biofilm-active microorganisms, but a prosthesis-free interval of at least 3 months is recommended.
Upper Extremity Department, Schulthess Clinic, Zürich, Switzerland. christoph.spormann@kws.ch
Christoph
C
Spormann
Yvonne
Y
Achermann
Beat R
BR
Simmen
Hans-Kaspar
HK
Schwyzer
Markus
M
Vogt
Jörg
J
Goldhahn
Christoph
C
Kolling
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003646:Debridement / Q000379:methods*; D020878:Device Removal; D058569:Elbow Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000601:surgery; D010147:Pain Measurement; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents