Abstract
Abstract Background: Elbow arthroplasty is increasingly performed in patients with rheumatic and posttraumatic arthritis. Data on elbow periprosthetic joint infection (PJI) is limited. We investigated characteristics and outcome of elbow PJI in a 14-year cohort of total elbow arthroplasties in a single center. Methods: 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, presence of sinus tract or microbial growth. A Kaplan-Meier survival method and Cox proportional hazard analysis was performed. Results: Of 358 elbow prostheses, PJI was identified in 27 (7.5%). The median patient age was 61 (39-82) years, 63% were females. 17 patients (63%) had a rheumatic disorder and 10 (37%) 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% confidence interval) was 79% (63% - 95%) after 1 year and 65% (45% - 85%) after 2 years. The outcome after 2 years was significantly better when treated according to the algorithm than in patients which were not (100% versus 33%, p <0.05).In 21 patients treated with debridement and retention, the cure rate was also higher when the algorithm was followed (100% versus 11%, p <0.05). Conclusions: This study suggests 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.
Achermann, Y