Indications and Reoperation Rates for Total Elbow Arthroplasty: An Analysis of Trends in New York State

Lyman, Stephen; Do, Huong; Hotchkiss, Robert N.; Marx, Robert G.; Daluiski, Aaron

doi:10.2106/jbjs.j.01128

Cited by 142 publications

(94 citation statements)

References 29 publications

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“…Since relatively few TEAs are performed compared to hip and knee arthroplasties, the incidence of fungal PJI in TEA is unknown [6]. The most common organisms in fungal PJI are Candida species [7].…”

Section: Discussionmentioning

confidence: 99%

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

2017

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BackgroundWith improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase. Despite these advances, complication rates remain as high as 24%. Of these complications periprosthetic joint infection is one of the most common and morbid. The rheumatoid elbow remains a leading indication for total elbow arthroplasty. Patients with this condition frequently require immunosuppressive therapy, which places them at higher risk of both typical and atypical infections.Case presentationWe present the case of a persistent, late-onset periprosthetic joint infection in a total elbow arthroplasty of a 64-year-old Caucasian woman with severe refractory rheumatoid arthritis. The offending pathogen, Aspergillus terreus, is previously unreported in the arthroplasty literature and grew concurrently with coagulase-negative staphylococcus. Eradication of the fungal and bacterial agents involved resection arthroplasty, serial debridement, and multiple courses of intravenous and oral antimicrobial therapy. Two attempts at reimplantation arthroplasty failed to eliminate the infection and our patient ultimately required definitive resection arthroplasty.ConclusionsArthroplasty in the rheumatoid elbow confers with it a high complication rate. Inflammatory disease and immunosuppressive drugs combined with the subcutaneous anatomy of the elbow contribute to the risk of infection. Fungal periprosthetic joint infection in the rheumatoid patient presents both diagnostic and therapeutic challenges. Fungal growth should always be treated and requires organism-specific antimicrobials in conjunction with surgical debridement. More literature is needed to determine the optimal treatment regimen for this devastating complication.

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Section: Discussionmentioning

confidence: 99%

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

2017

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“…In 1997, the main indication for TEA in the State of New York, United States, was rheumatoid arthritis. However, in 2006 a shift was seen to trauma as the main indication for TEA [5] . Today, both the linked sloppy hinged and unlinked TEA's are available.…”

Section: The Presentmentioning

confidence: 99%

“…It is performed more often in women than in men [3] and is also used in relatively young patients [4,5] . The number of of TEA performed annually is 1.4 in 100000 of the population, considerably less than the 70 to 99 in 100000 of the population for total hip replacement [4,6] .…”

Section: Introductionmentioning

confidence: 99%

Total elbow arthroplasty is moving forward: Review on past, present and future

Prkić

Bergen

Eygendaal

2016

WJO

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The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps have been taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.

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“…15 The impact of patient demographics in the setting of loosening and delayed fracture formation is most apparent in the difference of revision rates, with 4.8%, 8.3%, and 14.7% for traumatic, inflammatory arthritis, and osteoarthritis groups, respectively. 16 Implantation of any type of hardware, including elbow replacements, can be complicated by infection, seen as aggressive osteolysis, reactive periostitis, and soft tissue swelling (►Fig. 4).…”

Section: Total Elbow Replacementmentioning

confidence: 99%

Imaging of Elbow Replacement Arthroplasty

Roth

Chew

2015

Semin Musculoskelet Radiol

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Elbow replacement arthroplasty has become a standard surgical treatment for a variety of diseases of the elbow. First popularized for the treatment of late-stage rheumatoid arthritis and other debilitating forms of joint disease, the current indications have expanded to include primary treatment of elbow trauma. The most commonly used total elbow replacements are linked semiconstrained chromium-molybdenum alloy or titanium alloy prostheses with polyethylene bearing surfaces. These are inserted after resection of the ulnotrochlear joint and typically cemented in place; the radial head is often sacrificed. Modular metal components or massive osteoarticular allografts may be used when there is extensive bone deficiency. Metal radial head replacements are increasing being used for primary fracture treatment and in posttraumatic elbow reconstructive surgery. Long-term outcomes for total elbow replacement are similar to those of other joints, with 10-year survivals of ∼ 90%. Complications specific to elbow implants include infection, aseptic loosening, prosthetic failure, and periprosthetic fracture.

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Indications and Reoperation Rates for Total Elbow Arthroplasty: An Analysis of Trends in New York State

Cited by 142 publications

References 29 publications

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

Total elbow arthroplasty is moving forward: Review on past, present and future

Imaging of Elbow Replacement Arthroplasty

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