title: Infection in total elbow arthroplasty with stable components: outcomes of a staged surgical protocol with retention of the components.
abstract: OBJECTIVE
  We describe the use of a protocol of irrigation and debridement (I&D) with retention of the implant for the treatment of periprosthetic infection of a total elbow arthroplasty (TEA). This may be an attractive alternative to staged re-implantation.
  
  
  METHODS
  Between 1990 and 2010, 23 consecutive patients were treated in this way. Three were lost to follow-up leaving 20 patients (21 TEAs) in the study. There were six men and 14 women. Their mean age was 58 years (23 to 76). The protocol involved: component unlinking, irrigation and debridement (I&D), and the introduction of antibiotic laden cement beads; organism-specific intravenous antibiotics; repeat I&D and re-linkage of the implant if appropriate; long-term oral antibiotic therapy.
  
  
  RESULTS
  The mean follow-up was 7.1 years (2 to 16). The infecting micro-organisms were Staphylococcus aureus in nine, coagulase-negative Staphylococcus in 13, Corynebacterium in three and other in six cases. Re-operations included three repeat staged I&Ds, two repeat superficial I&Ds and one fasciocutaneous forearm flap. One patient required removal of the implant due to persistent infection. All except three patients rated their pain as absent or mild. Outcome was rated as good or excellent in 15 patients (mean Mayo Elbow Performance Score 78 points, (5 to 100) with a mean flexion-extension arc of 103° (40° to 150°)).
  
  
  CONCLUSIONS
  A staged protocol can be successful in retaining stable components of an infected TEA. Function of the elbow may compare unfavourably to that after an uncomplicated TEA. Cite this article: Bone Joint J 2016;98-B:976-83.
authors.affiliation: University of Nebraska Medical Center, Nebraska, NE, USA and Nebraska Medical Center Omaha, NE 68198, USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Streubel
authors.affiliation: Hospital Alemán, Av. Pueyrredón 1640, ZC 1118, Buenos Aires, Argentina.
authors.forename: J P
authors.initials: JP
authors.lastname: Simone
authors.affiliation: Mayo Clinic, 200 1st St. SW, Rochester, MN 55902, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: Morrey
authors.affiliation: Mayo Clinic, 200 1st St. SW, Rochester, MN 55902, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sanchez-Sotelo
authors.affiliation: Mayo Clinic, 200 1st St. SW, Rochester, MN 55902, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Morrey
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057929:Arthroplasty, Replacement, Elbow; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Component retention; Infection; Total elbow arthroplasty; Two-stage re-implantation