title: Triceps insufficiency after the treatment of deep infection following total elbow replacement.
abstract: 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.
authors.affiliation: University at Buffalo, Department of Orthopaedic Surgery, 462 Grider Street, Buffalo, New York 14215, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Duquin
authors.forename: J A
authors.initials: JA
authors.lastname: Jacobson
authors.forename: C D
authors.initials: CD
authors.lastname: Schleck
authors.forename: D R
authors.initials: DR
authors.lastname: Larson
authors.forename: J
authors.initials: J
authors.lastname: Sanchez-Sotelo
authors.forename: B F
authors.initials: BF
authors.lastname: Morrey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D003646:Debridement / Q000009:adverse effects; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D058569:Elbow Prosthesis / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000000981:diagnostic imaging / Q000209:etiology*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D056740:Olecranon Process / Q000000981:diagnostic imaging / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies
keywords: Debridement; Function; Infection; Re-implantation; Total elbow replacement; Triceps