INFECTION AFTER TOTAL ELBOW ARTHROPLASTY

The purpose of this study was to review our experience with the treatm ent of twenty-five infections (in twenty-five patients) after total el bow arthroplasty and to examine indications for salvage of the prosthe sis compared with those for resection arthroplasty. The patients were divided into three groups on the basis of treatment, Group I comprised fourteen patients who were managed with multiple, extensive irrigatio n and debridement procedures with retention of the original components . The primary indication for retention of the prosthesis was evidence that it was well fixed as determined both radiographically and intraop eratively. Group II comprised six patients who had removal of the pros thesis and debridement followed by immediate or staged reimplantation. Group III comprised five patients who were managed with resection art hroplasty. The infection was successfully eradicated in seven of the f ourteen elbows that had salvage of the prosthesis with irrigation and debridement. The results were strongly dependent on the causative orga nism; attempts at debridement failed in the four elbows that were infe cted with Staphylococcus epidermidis compared with three of the ten th at were infected with another organism. Four of the six patients in Gr oup II had successful reimplantation of a prosthesis; in three, the in fection had been caused by an organism other than Staphylococcus epide rmidis, Only one of the three patients who had a Staphylococcus epider midis infection had a successful reimplantation, None of the five pati ents who had a resection arthroplasty had signs of infection at the la test follow-up examination. We concluded that salvage of the prosthesi s with extensive irrigation and debridement in the presence of an infe ction about the elbow can be reasonably successful if the infecting or ganism is not Staphylococcus epidermidis and if the components are wel l fixed. When removal of the components is warranted, staged reimplant ation can also be highly successful when the infecting organism is not Staphylococcus epidermidis. However, the repeated operations necessar y to retain a prosthesis and the high rates of complications seen with this approach - and the relatively good rates of satisfaction obtaine d with resection arthroplasty - suggest that resection arthroplasty re mains the procedure of choice in medically frail patients or in patien ts for whom function of the elbow is less of a concern.