title: Two-stage revision for the treatment of the infected total elbow arthroplasty.
abstract: 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 recurrent infections (11.5%) in those patients who underwent a second-stage procedure. The infection presented at a mean of eight months (5 to 10) post-operatively. The mean Mayo Elbow Performance Score (MEPS) in those who underwent a second stage revision without recurrent infection was 81.1 (65 to 95). Staged revision surgery is successful in the treatment of patients with an infected TEA and is associated with a low rate of recurrent infection. However, when infection does occur, this study would suggest that it becomes apparent within ten months of the second stage procedure.
authors.affiliation: University Hospital of South Manchester, Shoulder and Elbow Unit, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Peach
authors.forename: S
authors.initials: S
authors.lastname: Nicoletti
authors.forename: T M
authors.initials: TM
authors.lastname: Lawrence
authors.forename: D
authors.initials: D
authors.lastname: Stanley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D003131:Combined Modality Therapy; D004337:Drug Carriers; D004551:Elbow Joint / Q000000981:diagnostic imaging; D058569:Elbow Prosthesis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011184:Postoperative Period; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004337:Drug Carriers
keywords: Arthroplasty; Elbow; Infection; Periprosthetic; Replacement; Revision