Characteristics and outcome of 27 elbow periprosthetic joint infections: results from a 14-year cohort study of 358 elbow prostheses

Abstract

Elbow arthroplasty is increasingly performed in patients with rheumatic and post-traumatic arthritis. Data on elbow periprosthetic joint infection (PJI) are limited. We investigated the characteristics and outcome of elbow PJI in a 14-year cohort of total elbow arthroplasties in a single centre. 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, the presence of sinus tract or microbial growth. A Kaplan-Meier survival method and Cox proportional hazard analysis were performed. Of 358 elbow prostheses, PJI was identified in 27 (7.5%). The median patient age (range) was 61 (39-82) years; 63% were females. Seventeen patients (63%) had a rheumatic disorder and ten (37%) had 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% CI) was 79% (63-95%) after 1 year and 65% (45-85%) after 2 years. The outcome after 2 years was significantly better when patients were treated according to the algorithm compared to patients who were not (100% vs. 33%, p <0.05). In 21 patients treated with debridement and retention, the cure rate was also higher when the algorithm was followed (100% vs. 11%, p <0.05). The findings of the present study suggest 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.

Prosthetic Joint Infection

“…In contrast, a systematic review of elbow arthroplasties found that 3.3% become infected (12). The reasons for the apparent higher infection rate may include the increased number of patients with rheumatoid arthritis receiving elbow arthroplasties (13) and the limited soft tissue envelope surrounding the elbow.…”

“…Another small study found a higher risk of PJI in men (56). Age, gender, underlying joint disease, and type of arthroplasty were not associated with an increased risk of PJI in a study of 27 elbow arthroplasty infections occurring in 358 patients (13).…”

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

“…The implementation of algorithms seems beneficial to establish clinical recommendations that can be followed even by the non-expert. Even though established for hip and knee joint prostheses, and suggested for other PJI [29,30], very few data is available on the actual implementation in clinical routine [4,5,7,12]. We are therefore presenting the results of our PJI algorithm in clinical day-to-day routine on a collective of 147 cases without selection bias or exclusion criteria.…”

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

“…P eriprosthetic joint infection (PJI) is a rare complication affecting between 0.7% and 2.4% of patients receiving joint arthroplasty [1][2][3][4][5][6][7][8][9] . A PJI after hip or knee arthroplasty in particular has extremely negative effects on the physical, emotional, social, and economic aspects of a patient's life 10 .…”