The management of infected elbow arthroplasty by two-stage revision

Rudge, Will; Eseonu, Kelechi; Brown, Matthew T.; Warren, Simon; Majed, Addie; Bayley, Ian; Lambert, Simon; Higgs, Deborah; Falworth, Mark

doi:10.1016/j.jse.2017.12.033

Cited by 28 publications

(30 citation statements)

References 21 publications

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“…of participantsNo. of elbows jointsQuality scoreOne-stage Gille, 2006 [23]Germany1978–199962.70.0RA (100%)NA S. aureus Flucloxacillin6.81015610 Spormann, 2012 [24]Switzerland1994–2007*67.00.0NRNA CNSA Oral ciprofloxacin/rifampin given4.00NRNR1111Two-stage Yamaguchi, 1998 [12]USA1981–199453.840.0RA (80%); OA (20%)3.7 S. aureus; S. epidermidis None given4.11015511 Yamaguchi, 1999 [22]USA1981–199459.728.6RA (85.7%); PTA (14.3%)NR S. aureus; S. epidermidis NR4.31047710 Achermann, 2011 [13]Switzerland1994–2007NRNRRA; OA5.5NRFlucloxacillin/rifampinNR0NRNR229 Spormann, 2012 [24]Switzerland1994–200754.5100RA; PTA; OA; psoriasisNR CNSA Flucloxacillin/rifampin6.40NRNR4411 Peach, 2013 [25]UK1998–201065.030.3RA; fracture; OA; PTA9.0 CNSA Cefuroxime4.3402333411 Rudge, 2018 [26]UK2009–201464.731.6RA; PTA; fracture; OA6....…”

Section: Resultsmentioning

confidence: 99%

One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

Kunutsor

Beswick

Whitehouse

et al. 2019

BMC Musculoskelet Disord

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BackgroundProsthetic joint infection (PJI) is a challenging complication of total elbow replacement (TER). Potential surgical treatments include one- or two-stage revision; however, the best treatment for elbow PJI is not clearly defined. We conducted a systematic review in accordance with PRISMA guidelines to compare the clinical effectiveness of one- and two-stage revision surgery for elbow PJI using re-infection (recurrent and new infections) rates; mortality; clinical measures of function, pain, and satisfaction; and non-infection related adverse events.MethodsMEDLINE, Embase, Web of Science, and The Cochrane Library were searched up to June 2019 to identify observational cohort studies and randomised controlled trials (RCTs) that had recruited patients with elbow PJI following TER and treated with one- or two-stage revision. Of 96 retrieved articles, 2 one-stage and 6 two-stage revision studies were eligible. No RCT was identified. Arcsine transformation was used in estimating rates with 95% confidence intervals (CIs).ResultsStaphylococcus aureus was the most common causative organism for PJI of the elbow (24 of 71 elbow PJIs). The re-infection rate (95% CI) for one-stage (7 elbows) ranged from 0.0% (0.0–79.3) to 16.7% (3.0–56.4) and that for two-stage revision (87 elbows) from 0.0% (0.0–49.0) to 20.0% (3.6–62.4). Non-infection related adverse event rate for one-stage (based on a single study) was 16.7% (3.0–56.4) and that for two-stage ranged from 11.8% (4.7–26.6) to 20.0% (3.6–62.4). There were no mortality events recorded following one- or two-stage revision surgery and postoperative clinical measures of function, pain, and satisfaction could not be effectively compared because of limited data.ConclusionsNo strong conclusions can be drawn because of limited data. The one-stage revision may be potentially at least as clinically effective as two-stage revision, but further data is needed. There are clear gaps in the existing literature and studies are urgently warranted to assess the clinical effectiveness of one- and two-stage revision strategies for PJI following TER.Systematic review registrationPROSPERO 2018: CRD42018118002.

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Section: Resultsmentioning

confidence: 99%

One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

Kunutsor

Beswick

Whitehouse

et al. 2019

BMC Musculoskelet Disord

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“…Guidelines on treatment options such as removal versus retention of the implant in case of periprosthetic infection of the elbow have been written by Morrey et al 15 Most knowledge on periprosthetic elbow infections is from TEA. 63 The guidelines on possible implant retention will also apply to RHA, with the advantage of RHA being that removal of the prosthesis will be better tolerated.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Management of the failed radial head arthroplasty

et al. 2020

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Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint. Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055

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“…Although a consensus is not fully established, two-stage revision surgery is commonly recommended. [79][80][81] Zmistowski et al 82) reported that two-stage revision led to a decreased rate of recurrent PJI and a 50% success rate over 3 years, and they recommended a prosthesis-free interval of at least 3 months. The most common pathogen was Staphylococcus aureus.…”

Section: Periprosthetic Joint Infectionmentioning

confidence: 99%

Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery

2019

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Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients. Total elbow prostheses have evolved over the years and now include the linked, unlinked, and convertible types. However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Here, we introduce each type of implant and evaluate clinical outcomes and complications by reviewing the previous literature.

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The management of infected elbow arthroplasty by two-stage revision

Cited by 28 publications

References 21 publications

One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

Management of the failed radial head arthroplasty

Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery

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