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Reimplantation of a Total Elbow Prosthesis Following Resection Arthroplasty for Infection

Cheung, Emilie V. MD; Adams, Robert A. OPA-C; Morrey, Bernard F. MD

Journal of Bone & Joint Surgery - American Volume: 01 March 2008 - Volume 90 - Issue 3 - p 589–594
doi: 10.2106/JBJS.F.00829
Scientific Articles

Background: The best approach for treatment of infection after total elbow arthroplasty is not clearly defined. The purpose of this study was to report our experience with reimplantation of a total elbow prosthesis following a prior resection arthroplasty to treat infection.

Methods: Between 1976 and 2003 at our institution, twenty-nine patients were treated with reimplantation of a total elbow prosthesis after a prior resection arthroplasty following a deep periprosthetic infection. Eleven of the twenty-nine patients had had at least one procedure performed on the elbow prior to the primary arthroplasty. The mean time interval between the resection arthroplasty and the reimplantation was 72.5 weeks. Patients were followed for an average of 7.4 years after the reimplantation. All patients were assessed clinically, and their medical records were retrospectively reviewed.

Results: The mean total Mayo Elbow Performance Score (MEPS) was 35.5 points (range, 15 to 60 points) before the reimplantation and 66.3 points (range, 20 to 100 points) postoperatively (p < 0.001). The most common infecting organism was Staphylococcus epidermidis, which was present in thirteen (45%) of the twenty-nine elbows, followed by methicillin-sensitive Staphylococcus aureus, which was present in seven (24%). The infection was not eradicated in eight elbows (28%).

Conclusions: Reimplantation of a total elbow prosthesis after a prior resection arthroplasty is a reasonable option for the treatment of infection. Improvement in function can be expected in most patients. However, the chance of the infection recurring and requiring additional revision surgery is high.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopedic Surgery, Stanford University, 300 Pasteur Drive, Edwards R155, Stanford, CA 94305

2Mayo Clinic, 200 First Street S.W., Rochester MN 55905

Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated
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